对劳拉·卡茨·奥尔森的回应

IF 0.5 Q4 POLITICAL SCIENCE
Peter A. Swenson
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引用次数: 0

摘要

劳拉·奥尔森(Laura Olson)对我的书的评论很好地调查了我所说的20世纪初美国治疗学的商业入侵,以及由此产生的逐利和医疗保健的有毒混合物。虽然我的书在很大程度上关注了有组织的医学与制药行业长期和持续的纠缠,但她关注的是更晚的商业入侵——企业资本进入提供者和患者之间的临床接触。我们都谈到了金钱和药物不健康的混合物中的另一个成分——政治。在《道德挑战》一书中,奥尔森正确地将我们的注意力引向了体育在国会大厅中行使权力,以牺牲良好的医疗保健为代价获取巨额利润的行为。利润产生保护和增加利润的动力。在《紊乱》一书中,我关注的是在PE侵入之前,医学病理的“上游”制度原因的演变。其根源是有组织的医学与制药工业的联盟。最重要的是,这种医学-政治联盟的遗留问题包括阻碍全民保健,从而阻碍商业化的保健筹资和提供的蓬勃发展。私募股权因此进入了收购的有利环境。举个例子:在20世纪40年代早期,美国医学协会(AMA)筹集了100万美元,成功地发起了一场大规模的运动,反对国家健康保险,从而维护了“美国医疗体系”。其中约90%来自大型制药公司。在20世纪50年代,美国医药协会和制药行业开始纠缠在一起,两者之间打开了一扇旋转门:1958年,美国制药协会(PMA)将主席职位交给了美国医药协会杂志的强大编辑,然后在1963年,他转到一个更赚钱的工作,成为帕克-戴维斯公司的总裁。PMA随后用AMA的执行副总裁取代了他。钱绕回来了。在20世纪60年代早期,17家最大的制药公司在美国医学协会的政治行动委员会对抗医疗保险的头三年里给了将近100万美元,部分原因是担心联邦政府对药品价格的控制。尽管美国药品协会-制药联盟在反对医疗保险方面失败了(除了确保药品不被覆盖和保留按服务收费的药品),但它成功地阻止了全民政府医疗保健,为最终的“下游”商业化pe医疗现象打开了大门。具有讽刺意味的是,20世纪20年代以来,保守的美国医疗协会曾激烈地反对私人医疗保险,称其为“企业医疗实践”,但最终在其认可的条款(同样,最重要的是,按服务收费)下与之和解。但它目前对新公司入侵的反应是完全无力的。它表达了更多的担忧
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Response to Laura Katz Olson
Laura Olson’s review of my book nicely surveys, among other things, what I say about the commercial invasion of American therapeutics early in the 20th century and the toxic mixture of profit seeking and health care that resulted. While my book focuses to a great extent on organized medicine’s long-standing and continuing entanglements with the drug industry, she looks at much later commercial invasion—of corporate capital into the clinical encounter between provider and patient. We both address another ingredient—politics—in the insalubrious cocktail of money and medicine. In Ethically Challenged, Olson rightly directs some of our attention to PE’s exercise of power in the halls of Congress that makes its huge profits at the expense of good health care possible. Profits generate power to protect and increase profits. In Disorder, I focus on the evolution of what might be called the “upstream” institutional causes of pathologies in medicine predating PE’s invasion. At the root of that was organized medicine in alliance with the pharmaceutical industry. A legacy of that medico-political alliance includes, most importantly, the obstruction of universal health care and therefore the flourishing of commercialized health care financing and delivery. PE therefore entered a congenial environment for takeover. To illustrate: in the early 1940s, the American Medical Association (AMA) raised $1 million for a massive and successful campaign to fight national health insurance and therefore preserve the "American system of medicine." About 90% of that came from huge drug companies. In the 1950s, the AMA and the drug industry became enmeshed, and a revolving door opened between the two: in 1958, the Pharmaceutical Association of America (PMA) handed its presidency to the powerful editor of the AMA journal, who then, in 1963, moved on to a more lucrative job as president of Parke-Davis. The PMA then replaced him with the AMA’s executive vice president. Money circled back. In the early 1960s, 17 of the largest drug firms gave nearly $1 million to the AMA’s political action committee in the first three years of its efforts to fight Medicare, in part out of fear of federal controls on drug pricing. Although the AMA-pharma alliance failed against Medicare (except by making sure drugs were not covered and by preserving fee-for-service medicine), its successful obstruction of universal government health care opened the locks for the eventual “downstream” phenomenon of commercialized PE-care. Ironically, the conservative AMA of the 1920s onward had fiercely fought private health insurance as the “corporate practice of medicine” before eventually making peace with it on terms it approved of (again, most importantly, fee-for-service payment). But its current response to the new corporate invasion is downright feeble. It expresses worries more
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来源期刊
New Political Science
New Political Science POLITICAL SCIENCE-
CiteScore
1.00
自引率
16.70%
发文量
53
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