Health Security for All: Dreams of Universal Health Care in America

Extract

Alan Derickson, Health Security for All: Dreams of Universal Health Care in America , Baltimore: Johns Hopkins University Press, 2005. Pp. 256. $30. ISBN 0–8018–8081–5.

Alan Derickson provides an insight into a puzzle which has intrigued students of health politics for many years. Why has the world's richest nation, the world leader in medicine, failed to produce a system which provides a reasonable level of access for its citizens? America spends more on health care than any other advanced industrial society, yet around 40 per cent of its citizens have no secure access to its benefits. The problem that lies behind the puzzle can be stated simply. In the twentieth century, medical science began to produce treatments that were highly desirable but so costly as to put many of them beyond the reach of even relatively prosperous individuals. The answer might also seem simple: some way must be found, through taxation or insurance, to accumulate funds on which individuals could draw on their ‘rainy day’. In America, agreement in principle was achieved remarkably quickly. By 1921, even the Council of the American Medical Association, the assassin of most reforms, was prepared to state that the most important function of the profession was ‘to secure for all the public the benefits of modern medical practice and to develop intelligent practical plans to furnish the best medical service possible in each community’. However, as Derickson demonstrates, there was more than one devil in the detail.