In the wake of the recent unsuccessful drive for health care reform, many people have been asking themselves what brought about the failure of this as well as past attempts to make health care accessible to all Americans. The author of this original exploration of U.S. health policy supplies an answer that is bound to raise some eyebrows. After a careful analysis of the history and issues of health care, David Rothman concludes that it is the average employed, insured "middle class"--the vaguely defined majority of American citizens--who deny health care to the poor.
The author advances his argument through the examination of two distinctive characteristics of American health care and the intricate links between them: the ubiquitous presence of technology in medicine, and the fact that the U.S. lacks a national health insurance program. Technology bears the heaviest responsibility for the costliness of American medicine. Rothman traces the histories of the "iron lung" and kidney dialysis machines in order to provide vivid evidence for his claim that the American middle class is fascinated by technology and is willing to pay the price to see the most recent advances in physics, biology, and biomedical engineering incorporated immediately in medical care. On the other hand, the lack of a universal health insurance program in the U.S. is rooted in the fact that, starting in the 1930s, government health policy has been a reflection of the needs and concerns of the middle class. Playing up to middle class sensibilities, the American presidents, Senate
and Congress based their policy upon the private rather than the public sector, whenever possible. They encouraged the purchase of insurance based on the laws of the marketplace, not provided by the government. Private health insurance and high-tech medicine came with a hefty price, with the end result that about 40 million Americans could not afford medical care and were left to fend for themselves. The author investigates the moral values underpinning these decisions, and goes to the bottom of the problem of why the United States remain the only developed country which continually proves unable to provide adequate health care to all its citizens.
Industry Reviews
"Rothman's book is an engaging, interesting, and complex one, easy to read, more difficult to evaluate....The episodes are enourmously interesting on their own...Rothman covers the ground other have plowed, but he does so with a craftsman's eye for the compelling detail, the vivid illustration, and the example that supports the message of his tale....Taken as a collection of fascinating tales, this is a book well worth reading by any student of American
medicine."--Theodore R. Marmor, Ph.D, The New England Journal of Medicine
"Carefully argued and illuminating..."--The New York Review
"Rothman's argument is nuanced and historically informed; his writing is clear and straightforward: and his conclusion...is thought-provoking and unsettling."--Annals of Internal Medicine
"The major strength of this book is the currency, clinical relevance, and clarity and readability of the text..."--Doody's Journal
"There is much to be learned from this book, both in the history of American health care and in Rothman's often trenchant political analysis. In an environment in which policymakers' institutional memory can apparently be measure in months, not years, there is always benefit to being reminded of how we came to arrive at our current circumstances....One can thus take great pleasure-and learn a lot-from Beginnings Count..."--Health Affairs
"Rothman's book is an engaging, interesting, and complex one, easy to read, more difficult to evaluate....The episodes are enourmously interesting on their own...Rothman covers the ground other have plowed, but he does so with a craftsman's eye for the compelling detail, the vivid illustration, and the example that supports the message of his tale....Taken as a collection of fascinating tales, this is a book well worth reading by any student of American
medicine."--Theodore R. Marmor, Ph.D, The New England Journal of Medicine
"Carefully argued and illuminating..."--The New York Review
"Rothman's argument is nuanced and historically informed; his writing is clear and straightforward: and his conclusion...is thought-provoking and unsettling."--Annals of Internal Medicine
"The major strength of this book is the currency, clinical relevance, and clarity and readability of the text..."--Doody's Journal
"There is much to be learned from this book, both in the history of American health care and in Rothman's often trenchant political analysis. In an environment in which policymakers' institutional memory can apparently be measure in months, not years, there is always benefit to being reminded of how we came to arrive at our current circumstances....One can thus take great pleasure-and learn a lot-from Beginnings Count..."--Health Affairs
Noted in The Indianapolis Star
"...beautifully written....well worth reading"--Medical Humanities Review
"...Beginnings Count deserves to be widely read and its implications vigorously debated."--SCIENCE
"...Rothman's impassioned analysis of class and medical technology may deservedly win more readers to history than drier, more circumspect tomes."--Medical History
"Rothman is most successful in illustrating modern society's preoccuption with medical technology -- the "magic bullets" that help compensate, though not entirely and not equitably, for the life-styles, socioeconomic conditions, and environmental elements that dictate health outcomes. The case studies demonstrate the powerful social bias toward innovation and diffusion of any technology with significant benefits for identifiable individuals."--The Journal
of American History
Noted in the Journal of Ethics, Law, and Aging
