U.S. Health Policy and Health Care Delivery: Doctors, Reformers and Entrepreneurs

The health care system in the United States has never been an easy one to understand. If a doctorate degree is needed to practice medicine, then two doctorates, a master's degree, and a focus on lifelong learning are needed to understand the methods of how health care is provided and paid for in America. Most Americans have trouble describing the differences between a physician, a nurse practitioner and a physician assistant, so it is no wonder many have trouble understanding the differences between PPOs, HMOs, MCOs, Medicare Part A, Medicare Part B, PCT Codes or any other of the numerous acronyms that health care providers use on a daily basis. That's why it was a bit refreshing to find a book that takes the reader through the history of health care in the United States in a way that is easy to follow and easy to digest.

If there is one complaint I have about Carl Ameringer's book, “U.S. Health Policy and Health Care Delivery: Doctors, Reformers and Entrepreneurs,” it is the title. That is not to say the book does not address U.S. health policy, or health care delivery, or discuss the roles of doctors, reformers and entrepreneurs in health care; it very much does and does it well. But for me the title didn't properly represent the heart of the book — the journey through the ages of health care in the United States. Beginning in the late 1800s and moving through the decades, all the way to modern times, Mr. Ameringer takes the reader through the evolution of the U.S. health care system. We are shown the development of the modern physician, the creation of medical education systems focused on science and training, the establishment and evolution of the AMA from a progressive, science-focused institution to one of protectionism, the establishment of early insurance programs and their constant struggles with increasing costs and price controls, and through it all a preference for private control over “socialized medicine.”

Perhaps what surprised this reader the most was how much of what we consider “modern” health care issues are not modern at all — access to affordable health care has been an issue since before Franklin Roosevelt and the New Deal, and continues to be an issue following Barack Obama and the creation of Obamacare.

When I first started this book, I was not sure what benefit I would get out of it. There are no definitive answers given as to what will resolve the debate between cost and access, nor are there any direct corollaries to how regulators should alter or enhance their functions. However, when I finished, I found myself gaining a newfound understanding for how economics has, and will continue to play, a profound role in the health care system, and whether changes are needed to the entire approach in order to solve the problems that can arise as a result of economic influence.

One quote from Mr. Ameringer's book that stuck with me was a citation from Lawton Burns and Ralph Muller, stating: “Societal goals are clearly not the primary aim of economic integration… [R]evenue and income goals of providers seem to be the dominant motivation.” Perhaps a new focus of health care integration is needed before the issues of cost and access can be addressed? It will be interesting to see what Mr. Ameringer will write about the next age of health care in the United States.