Social Justice

Inescapable Decisions examines the disarray in the American health care system and proposes major corrective strategies. Mechanic shows that the high-technology interventionist type of medicine commonly practiced in the United States has lost its sense of priorities and balance. Expensive and sometimes dangerous procedures of unknown efficacy are used excessively and often inappropriately, while many basic preventive and primary care services remain unavailable to those who need them the most. This incredibly complex system of care operates in an environment of heavy-landed rules and regulations and enormous waste of resources.

To meet the needs of the rapidly changing world of health care, future physicans and health care providers will need to be trained to become wiser scientists and humanists in order to understand the social and moral as well as technological aspects of health and illness. The Social Medicine Reader is designed to meet this need. Based on more than a decade of teaching social medicine to first-year medical students at the pioneering Department of Social Medicine at the University of North Carolina, The Social Medicine Reader defines the meaning of the social medicine perspective and offers an approach for teaching it. Looking at medicine from a variety of perspectives, this anthology features fiction, medical reports, scholarly essays, poetry, case studies, and personal narratives by patients and doctors--all of which contribute to an understanding of how medicine and medical practice is profoundly influenced by social, cultural, political, and economic forces. What happens when a person becomes a patient? How are illness and disability experienced? What causes disease? What can medicine do? What constitutes a doctor/patient relationship? What are the ethical obligations of a health care provider? These questions and many others are raised by The Social Medicine Reader, which is organized into sections that address how patients experience illness, cultural attitudes toward disease, social factors related to health problems, the socialization of physicians, the doctor/patient relationship, health care ethics and the provider's role, medical care financing, rationing, and managed care.

From the era of slavery to the present day, the first full history of black America’s shocking mistreatment as unwilling and unwitting experimental subjects at the hands of the medical establishment. Medical Apartheidis the first and only comprehensive history of medical experimentation on African Americans. Starting with the earliest encounters between black Americans and Western medical researchers and the racist pseudoscience that resulted, it details the ways both slaves and freedmen were used in hospitals for experiments conducted without their knowledge—a tradition that continues today within some black populations. It reveals how blacks have historically been prey to grave-robbing as well as unauthorized autopsies and dissections. Moving into the twentieth century, it shows how the pseudoscience of eugenics and social Darwinism was used to justify experimental exploitation and shoddy medical treatment of blacks, and the view that they were biologically inferior, oversexed, and unfit for adult responsibilities. Shocking new details about the government’s notorious Tuskegee experiment are revealed, as are similar, less-well-known medical atrocities conducted by the government, the armed forces, prisons, and private institutions. The product of years of prodigious research into medical journals and experimental reports long undisturbed,Medical Apartheidreveals the hidden underbelly of scientific research and makes possible, for the first time, an understanding of the roots of the African American health deficit. At last, it provides the fullest possible context for comprehending the behavioral fallout that has caused black Americans to view researchers—and indeed the whole medical establishment—with such deep distrust. No one concerned with issues of public health and racial justice can afford not to readMedical Apartheid, a masterful book that will stir up both controversy and long-needed debate.

The Affordable Care Act's impact on coverage, access to care, and systematic exclusion in our health care system The Affordable Care Act set off an unprecedented wave of health insurance enrollment as the most sweeping overhaul of the U.S. health insurance system since 1965. In the years since its enactment, some 20 million uninsured Americans gained access to coverage. And yet, the law remained unpopular and politically vulnerable. While the ACA extended social protections to some groups, its implementation was troubled and the act itself created new forms of exclusion. Access to affordable coverage options were highly segmented by state of residence, income, and citizenship status. Unequal Coverage documents the everyday experiences of individuals and families across the U.S. as they attempted to access coverage and care in the five years following the passage of the ACA.It argues that while the Affordable Care Act succeeded in expanding access to care, it did so unevenly, ultimately also generating inequality and stratification. The volume investigates the outcomes of the ACA in communities throughout the country and provides up-close, intimate portraits of individuals and groups trying to access and provide health care for both the newly insured and those who remain uncovered. The contributors use the ACA as a lens to examine more broadly how social welfare policies in a multiracial and multiethnic democracy purport to be inclusive while simultaneously embracing certain kinds of exclusions. Unequal Coverage concludes with an examination of the Affordable Care Act's uncertain legacy under the new Presidential administration and considers what the future may hold for the American health care system. The book illustrates lessons learned and reveals how the law became a flashpoint for battles over inequality, fairness, and the role of government. More books on the health care debate

During the 1992 presidential campaign, health care reform became a hot issue, paving the way for one of the most important yet ill-fated social policy initiatives in American history: Bill Clinton's 1993 proposal for comprehensive coverage under "managed competition." Here Jacob Hacker not only investigates for the first time how managed competition became the president's reform framework, but also illuminates how issues and policies emerge. He follows Clinton's policy ideas from their initial formulation by policy experts through their endorsement by medical industry leaders and politicians to their inclusion--in a new and unexpected form--in the proposal itself. Throughout he explores key questions: Why did health reform become a national issue in the 1990s? Why did Clinton choose managed competition over more familiar options during the 1992 presidential campaign? What effect did this have on the fate of his proposal? Drawing on records of the President's task force, interviews with a wide range of key policy players, and many other sources, Hacker locates his analysis within the context of current political theories on agenda setting. He concludes that Clinton chose managed competition partly because advocates inside and outside the campaign convinced him that it represented a unique middle road to health care reform. This conviction, Hacker maintains, blinded the president and his allies to the political risks of the approach and hindered the development of an effective strategy for enacting it.

Produced in close consultation with state health care officials from all around the country, this important volume addresses the central implementation, management, and federalism dimensions of health reform. Chapters by some of the country's leading health policy and public management experts explore the administrative challenges of reform as they relate to health alliances, cost containment, quality of care, medical education and training, and other key issues. They discuss various working principles for developing an administratively sound health reform policy.

In no other country has health care served as such a volatile flashpoint of ideological conflict. America has endured a century of rancorous debate on health insurance, and despite the passage of legislation in 2010, the battle is not yet over. This book is a history of how and why the United States became so stubbornly different in health care, presented by an expert with unsurpassed knowledge of the issues. Tracing health-care reform from its beginnings to its current uncertain prospects, Paul Starr argues that the United States ensnared itself in a trap through policies that satisfied enough of the public and so enriched the health-care industry as to make the system difficult to change. He reveals the inside story of the rise and fall of the Clinton health plan in the early 1990s—and of the Gingrich counterrevolution that followed. And he explains the curious tale of how Mitt Romney’s reforms in Massachusetts became a model for Democrats and then follows both the passage of those reforms under Obama and the explosive reaction they elicited from conservatives. Writing concisely and with an even hand, the author offers exactly what is needed as the debate continues—a penetrating account of how health care became such treacherous terrain in American politics.

Since the late 1960s, health care in the United States has been described as a system in crisis. No matter their position, those seeking to improve the system have relied on the rhetoric of crisis to build support for their preferred remedies, to the point where the language and imagery of a health care crisis are now deeply embedded in contemporary politics and popular culture. In Cries of Crisis, Robert B. Hackey analyses media coverage, political speeches, films, and television shows to demonstrate the role that language and symbolism have played in framing the health care debate, shaping policy making, and influencing public perceptions of problems in the health care system. He demonstrates that the idea of crisis now means so many different things to so many different groups that it has ceased to have any shared meaning at all. He argues that the ceaseless talk of 'crisis,' without a commonly accepted definition of that term, has actually impeded efforts to diagnose and treat the chronic problems plaguing the American health care system. Instead, he contends, reformers must embrace a new rhetorical strategy that links proposals to improve the system with deeply held American values like equality and fairness.