If we can decode the human genome and fashion working machines out of atoms, why can't we navigate the quagmire that is our health care system? In this important new book, Julius Richmond and Rashi Fein recount the fraught history of health care in America since the 1960s. After the advent of Medicare and Medicaid and with the progressive goal to make advances in medical care available to all, medical costs began their upward spiral. Cost control measures failed and led to the HMO revolution, turning patients into consumers and doctors into providers. The swelling ranks of Americans without any insurance at all dragged the United States to the bottom of the list of industrialized nations.

Over the last century medical education was also profoundly transformed into today's powerful triumvirate of academic medical centers, schools of medicine and public health, and research programs, all of which have shaped medical practice and medical care. The authors show how the promises of medical advances have not been matched either by financing or by delivery of care.

As a new crisis looms, and the existing patchwork of insurance is poised to unravel, American leaders must again take up the question of health care. This book brings the voice of reason and the promise of compromise to that debate.

Rashi Fein and Julius Richmond bring a wealth of knowledge, long practical experience, and a welcome historical perspective to this excellent volume on the many aspects and causes of the steadily worsening health care crisis facing the nation. It's a continuing outrage that in today's America, the best and the worst in health care have existed side-by-side for so long in countless communities across the country. In this extraordinary era of nearly miracle-a-day new medical breakthroughs to prevent, treat, and even cure disease, inaction is unacceptable in the face of vast numbers of Americans with no health insurance, soaring inflation in the cost of health care, huge profits for the health insurance and pharmaceutical industries, and the very real danger of terrorist attacks with biological weapons. Genuine health reform is more urgent than ever, and the impressive recommendations of Fein and Richmond give us timely and important ideas about the direction such reform should take. Other modern nations have met and mastered this challenge, and America can too.

From their vast experience as both policymakers and respected scholars, Richmond and Fein have produced an authoritative account of the circumstances that created our present predicament and, more important, a thoughtful roadmap for how we can extricate ourselves from the quagmire. Their message is both practical and hopeful: the future of health care in this country is not 'preordained' by past decisions but will emerge from the choices still to be made. Their abiding optimism is both refreshing and timely.

Two of the giants of American medicine, public policy, and health policy have combined to produce a masterpiece detailing how our healthcare system came to be what it is, and how we can take it to the nextlevel--providing quality care and access for all. It is must reading for students of medicine, public health and health policy.

Over the course of their distinguished careers, the authors have participated in innumerable debates on matters of health care policy, large and small. They are veterans of fights over covering the uninsured, physician training, mental health, and substance abuse, and over funding for research, patient care, and medical education. They have extensive experience with the behavior of federal and state agencies, academic medical centers, insurers, and bureaucrats and bureaucracies, along with deep knowledge of the varying ways in which the United States has financed and delivered health care services. This book distills these experiences into a sophisticated historical and institutional perspective on why our health care system looks the way it does...The book is worth reading for the authors' perspective on how we ended up where we are and on ways and means of getting somewhere else.

We spend far more than any industrialized country on health care and get far less for it. How did we get here? Former surgeon general Richmond and medical economist Fein offer a judicious account...Bringing to this...important subject authoritative knowledge and insight, the authors slice through the intricacies like an experienced surgeon.

'In this authoritative and thoughtful book you will find what we need to know if we are to do anything about health care in America.'

If we can decode the human genome and fashion working machines out of atoms, why can't we navigate the quagmire that is our health care system? In this important new book, Julius Richmond and RashiFein recount the fraught history of health care in America since the 1960s. After the advent of Medicare and Medicaid and with the progressive goal to make advances in medical care available to all, medical costs began their upwardspiral. Cost control measures failed and led to the HMO revolution, turning patients into consumers and doctors into providers. The swelling ranks of Americans without any insurance at all dragged the United States to the bottom of thelist of industrialized nations.

Over the last century medical education was also profoundly transformed into today's powerful triumvirate of academic medical centers, schools of medicine and publichealth, and research programs, all of which have shaped medical practice and medical care. The authors show how the promises of medical advances have not been matched either by financing or by delivery of care.

As a new crisis looms, and the existing patchwork of insurance is poised to unravel, American leaders must again take up the question of health care. This book brings the voice of reason and thepromise of compromise to that debate.

Julius B. Richmond, M.D, is a founder of <>Head Startand the former Surgeon General under President Jimmy Carter. He is currently the John D. MacArthur Professor of Health Policy, Emeritus, at <>Harvard University.Rashi Fein, Ph.D., is Professor of Medical Economics, Emeritus, at <>Harvard Medical School, and the author of Medical Care, Medical Costs: The Search for a Health Insurance Policy.Jimmy Carteris Former President of the United States and was awarded the Nobel Peace Prize in 2002.

Foreword by Jimmy Carter

Introduction

Part I. The Early Years (1900-1965)

1. The Educational and Scientific Revolution: Higher Standards and Changing Priorities

2. The Consumer Revolution: Increasing Access to Medical Care

Part II. In the Wake of Medicare and Medicaid (1965-1985)

3. Emerging Tensions between Regulation and Market Forces: Dealing with Growth

4. Education for the Health Professions: The Impact of Growth

Part III. Moving to the Present (1985-2005)

5. The Entrepreneurial Revolution: A Changing Face for Medicine

6. Beyond the Dollars: Progress in Health and the Role of Public Health

Part IV. Anticipating the Next Revolution (2005 and Beyond)

7. Medical Challenges and Opportunities

8. Increasing Equity: Achieving Universal Health Insurance

Notes

Index