Remedy and Reaction: The Peculiar American Struggle over Health Care Reform

Review of: Remedy and Reaction: The Peculiar American Struggle Over Health Care Reform, by Paul Starr. New Haven: Yale University Press, 2013. 342 pp. $17.00 paper. ISBN: 978-­‐0-­‐300-­‐18915-­‐5 By: David N. Pellow. 2015. Contemporary Sociology 44(2): 256-­‐258 “Do we have an obligation to provide health care for our citizens?” Paul Starr opens this outstanding book with this question and follows up by asking another more vexing one: why is the U.S. health care system so stubbornly unique among capitalist democracies? It is a well-­‐known and embarrassing fact that the U.S. has the most expensive health care system in the world and yet has the highest number of uninsured citizens of any western democracy. But the solution to the problem has always eluded us. The answers to Starr’s questions vary widely across the political spectrum exposing deep divides between and within the major political parties and reveals how a combination of social forces prevents the U.S. from guaranteeing what people in many other democracies view as a fundamental right. Starr’s argument is that the U.S. missed a chance to set up a general system for financing health care in the first half of the 20 th century, and when the government finally sought to do so, the nation was caught in what he calls a policy trap, in which enough of the public and health care industry leaders were satisfied with the complicated and costly system that changing it became nearly impossible. He addresses the three factors usually indicted for producing the health care crisis in the U.S.: “special interests,” national values, and “the daunting complexity of the problems of health care and health policy.” And while Starr agrees that there is some truth within each of these explanations, he challenges the claim that any one of them alone is responsible for the quagmire that is our health care system. Of the three explanations, the argument that “special interests” have prevented major health care reform carries particular weight with many observers. After all, as Starr demonstrates throughout the book, the American Medical Association and other key stakeholders actively opposed anything resembling a national health care system virtually anytime the idea emerged in U.S. politics. But that explanation is too tidy because there have been moments when health care industry leaders have supported expanded coverage proposals that they viewed as better than less appealing alternatives such as single payer. The “special interest” explanation really falls short when we discover that the public itself is split over reform because unionized workers, veterans, disabled persons, and the elderly can access Medicare, while segments of low income populations can also qualify for Medicaid. These millions of Americans may not have the best health care, but they often see themselves as “reasonably well-­‐protected” and fear losing their coverage or benefits under any major reform, particularly since they feel they have earned their way into such programs while other groups are seen as less worthy. This, I believe, is the most disturbing and revealing aspect of the health care crisis in this country and— although Starr does not draw the link—has strong echoes of the kind of divisive