Health Care for Some

Reviewed by: Health Care for Some: Rights and Rationing in the United States since 1930 by Beatrix Hoffman Daniel M. Fox Beatrix Hoffman. Health Care for Some: Rights and Rationing in the United States since 1930. Chicago: University of Chicago Press, 2012. xxxv + 319 pp. Ill. $30.00 (978-0-226-34803-2). Hoffman arrays historical evidence in order to advocate on behalf of universal coverage of health services, equality in addressing patients’ needs as the only basis for allocating scarce resources, and access to a single public payer for care. She argues that every significant decision about health care coverage and financing during the past century—by government at every level, employers, private insurers, and providers—has either overtly or covertly rationed access to care, mainly by race, class, and geography. Even policies that accord groups of Americans a right to health care have invariably rationed it, she claims. For example, the Affordable Care Act of 2010 (ACA) expands access to care but “retains and updates many aspects of US-style rationing” (p. 217). Similarly, Medicare, Medicaid, the State Children’s Health Insurance Program, and employer-sponsored coverage have always rationed care (according to Hoffman’s definition of it [p. 268] as any “restriction or control of the consumption of a commodity or service”). Because, in her opinion, “medical need” is the only legitimate reason for rationing care, the American health system has always been “inequitable” (p. 159 and elsewhere). Most of the events Hoffman describes will be familiar to readers of articles and books on the history of health politics and policy in the United States. The nine chapters that follow a “Prologue: Rights and Rationing before 1930” present standard accounts of conflicts among interest and advocacy groups in the politics of health policy during the Great Depression, the Second World War, the “Rise of Private Health Insurance” (pp. 90ff.) during the postwar decades of prosperity, the enactment of Medicare and Medicaid, the “Rise of Health Care Activism” since the 1970s (pp. 143ff.), and the history of “Rights vs. Markets” from 1981 to 2008 (pp. 169ff.). In an epilogue, “Rights, Rationing, and Reform,” Hoffman summarizes accounts, mainly in print and electronic media, of the politics of enacting the ACA and speculates about its prospects. Hoffman does not take full account of significant articles and books by scholars of health politics and policy, even of those whose publications she cites. She ignores, for instance, negotiations about potential compromises on health policy between organized medicine and federal officials during the New Deal, the history of ideas about the regionalization of health services in hierarchies of technological sophistication that underlay the Hospital Survey and Construction Act of 1946 (establishing the Hill–Burton program), and the political reasons for several decades of bipartisan collaboration on policy for Medicare and Medicaid. As a result of selective reading in relevant literature, moreover, Hoffman sometimes distorts or ignores significant issues and evidence that bears on them. Examples include misstating how and why federal legislation preempted state regulation of self-insured employment-based health plans (p. 193), understating the public health response to 9/11 and Hurricane Katrina (pp. 201–5), dismissing in a few sentences the methods and uses of evidence-based health research [End Page 213] and its impact on policy since the 1980s (p. 214), and not taking account of John McDonough’s definitive—to date—history of the ACA (Inside National Health Reform, University of California Press and the Milbank Memorial Fund, 2011). It is unlikely that none of the thirty-three scholars she names as sources of “generous readings, comments and suggestions” (p. 224) alerted her to historiographical problems that can afflict historians when their political opinions guide their research and writing. The most common such problem may be selectivity about issues and evidence in order to support advocacy. Hoffman even ignores issues addressed by many of the colleagues she thanks, for example, how health policy and practice have been informed by changes in life expectancy, the burden of disease, and advances in biomedical science and its application. Daniel M. Fox Milbank Memorial Fund Copyright © 2014 The Johns Hopkins University Press

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