Barbara Ehrenreich

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Edward Edelson (review date 24 January 1971)

(Contemporary Literary Criticism)

SOURCE: "In Sickness and in Wealth," in The Washington Post, Vol. V, No. 4, January 24, 1971, pp. 1, 3.

[In the following review, Edelson praises The American Health Empire as an innovative look at the problems with health care in America, although he finds some flaws in the authors' presentation.]

The American Health Empire is yet another book about the sad state of American medicine—but don't stop reading there. This one is different. It is galvanizing, irritating, flawed and fascinating, and it presents an argument that has never been touched in what can be called the standard book on the health care crisis.

The standard book has been written under a score of titles by a score of authors. The standard book's villains and heroes are unvarying. On one side, in the black hats, are the old-line doctors, whose spokesman is the American Medical Association and whose aim is to keep American medicine disorganized in the interests of personal profit. The men in the white hats are the medical liberals, working out of modern hospitals and university-based medical centers, eager to press medical research, hopeful about drastically different methods of financing medical care (such as national health insurance) and anxious to use computers and the other tools of technology to end the present "nonsystem" of medical care for the benefit of the health consumer. If we can just help the liberals beat the AMA, says the standard book, our health care problems will be over.

It is at this point, where the standard book ends, that The American Health Empire begins. Its authors are members of a group of young activists working out of a self-created think-tank called the Health Policy Advisory Center. They present the reader with an entirely new villain—the very medical liberal whom most authors present as the last great hope of American medicine.

Health-PAC dismisses the AMA briefly as a declining organization whose prestige and power are falling rapidly, chiefly interested in fighting a forlorn rear guard action against the twentieth century. (Just last year, for the first time, the AMA's membership fell below 50 per cent of the nation's physician population. The AMA is now a minority group.)

With the AMA out of the way, Health-PAC follows the first rule of investigatory reporting: Look where the money goes. It finds that the money is going chiefly to the large university-based "medical empires" that are run by medical liberals. These centers carry on most medical research, use most of the new medical technology, sponsor most of the community action medical programs.

Between 1960 and 1969, Health-PAC says, the amount of money spent on medical care in the United States doubled, but the quality of medical care for most Americans held even at best, while costs are rocketing beyond the reach of even the respectable middle class. The standard book explains the paradox of rising costs and lowered standards by the greed of individual doctors. Health-PAC blames it on institutionalized greed—the greed of the "medical empires."

Those empires Health-PAC argues are not dedicated to medical care. Rather, they are dedicated to three goals: increasing institutional profits and individual salaries, feeding medical research that often has only a tenuous relationship to any real medical needs, and insuring its own perpetuation by controlling medical education. In short, the medical empire described by Health-PAC is essentially similar to any other unit of the technocracy described by John Kenneth Galbraith.

Health-PAC goes on to set forth what can only be called an institutionalized plot against good health care. Most of the money that pays for health care comes from Blue Cross, Blue Shield, Medicare and Medicaid, the book says. But the hospitals that get this money control the organizations that give the money, through a system of interlocking directorates. So "the Blues" never question the size of hospital bills—which means that the hospitals can raise prices as much as...

(The entire section is 29,828 words.)