Money, Solidarity, and Half a Century of Health Reform.

IF 0.6 4区 社会学 Q3 LAW
American Journal of Law & Medicine Pub Date : 2025-07-01 Epub Date: 2025-09-16 DOI:10.1017/amj.2025.10069
William M Sage
{"title":"Money, Solidarity, and Half a Century of Health Reform.","authors":"William M Sage","doi":"10.1017/amj.2025.10069","DOIUrl":null,"url":null,"abstract":"<p><p>This essay explores central aspects of the relationship between money and national health policy from the passage of Medicare in 1965 to the present, including the two most sweeping attempts at system reinvention during that period: the Patient Protection and Affordable Care Act of 2010 (ACA), and the failed Health Security Act of the early 1990s. Its point is not that ethical professionalism has prevailed, though it survives on the skill and dedication of nurses, physicians, and other health care workers. Rather, its point is that one should not criticize the morality of change without interrogating the morality of the status quo. In the 1990s, Jerome Kassirer wrote that \"a system in which there is no equity is, in fact, already unethical.\" The same can be said for a system that overfunds medical care and underfunds other essential social investments, including education. A system that, moreover, cannot be justified by the limited morality of competition in the marketplace because it does not - and could not absent radical change - perform as a functioning market would. In terms of robust market competition with its winners and losers, U.S. health care has been, at worst, a sheep in wolf's clothing.</p>","PeriodicalId":7680,"journal":{"name":"American Journal of Law & Medicine","volume":"51 2","pages":"314-336"},"PeriodicalIF":0.6000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Law & Medicine","FirstCategoryId":"90","ListUrlMain":"https://doi.org/10.1017/amj.2025.10069","RegionNum":4,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/16 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"LAW","Score":null,"Total":0}
引用次数: 0

Abstract

This essay explores central aspects of the relationship between money and national health policy from the passage of Medicare in 1965 to the present, including the two most sweeping attempts at system reinvention during that period: the Patient Protection and Affordable Care Act of 2010 (ACA), and the failed Health Security Act of the early 1990s. Its point is not that ethical professionalism has prevailed, though it survives on the skill and dedication of nurses, physicians, and other health care workers. Rather, its point is that one should not criticize the morality of change without interrogating the morality of the status quo. In the 1990s, Jerome Kassirer wrote that "a system in which there is no equity is, in fact, already unethical." The same can be said for a system that overfunds medical care and underfunds other essential social investments, including education. A system that, moreover, cannot be justified by the limited morality of competition in the marketplace because it does not - and could not absent radical change - perform as a functioning market would. In terms of robust market competition with its winners and losers, U.S. health care has been, at worst, a sheep in wolf's clothing.

金钱、团结和半个世纪的医疗改革。
本文探讨了从1965年通过医疗保险到现在,货币与国家卫生政策之间关系的核心方面,包括这一时期两次最彻底的系统重塑尝试:2010年的《患者保护和平价医疗法案》(ACA),以及20世纪90年代初失败的《健康安全法》。它的重点并不是道德职业已经盛行,尽管它依靠护士、医生和其他卫生保健工作者的技能和奉献精神得以幸存。相反,它的观点是,人们不应该在不质疑现状的道德的情况下批评变革的道德。在20世纪90年代,杰罗姆·卡西尔写道:“一个没有公平的制度实际上已经是不道德的了。”同样的道理也适用于一个医疗保健资金过多而其他基本社会投资(包括教育)资金不足的体制。此外,这种制度不能以市场竞争的有限道德为理由,因为它没有——也不可能没有激进变革——像一个运转良好的市场那样运作。就有赢家和输家的激烈市场竞争而言,美国的医疗保健在最坏的情况下是一只披着狼皮的羊。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
0.80
自引率
16.70%
发文量
8
期刊介绍: desde Enero 2004 Último Numero: Octubre 2008 AJLM will solicit blind comments from expert peer reviewers, including faculty members of our editorial board, as well as from other preeminent health law and public policy academics and professionals from across the country and around the world.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信