In its foreword Mark V. Pauly states ‘that Americans fear government mistakes in health care financing and regulation as much as they fear market failure’. The main tenor of American Health Care is that the financing and organisation of the health care system does not represent an ‘either/or’ situation, but rather requires government and business to don appropriate robes to effectively change it. To pass judgement on a work such as American Health Care proves to be an arduous task for not only does it contain the views and ideas of thirteen lawyers, economists and a historian, but it also pertains to four policy areas, to wit ‘Health Insurance and Finance’, ‘Health Care Services’, ‘Drugs and Medication’ and ‘Health Care Personnel’. At the core of the contributions of these authors are President Clinton’s health care reform proposals of 1993, the Health Security Act, and the question why this health care reform failed. The answer seems to be that ‘health care reform failed because people don’t trust government to manage their medical care’. This volume tries to analyse why government control of health care does not work.
As with any work consisting of contributions from various authors some contributions will be received better than others. This remains, however, a subjective opinion dependent on which point one departs from. All authors try to address the same dilemma, namely government versus business. Their main point is that there is no ‘either/or’ situation. The authors, although they disagree about the effects of regulation, agree that the health care industry is over regulated as it is. And they all seem to have an unlimited amount of faith in the private sector’s abilities, which can be seen both as a strength and a weakness of this work. Their outspoken views can be considered a strength to those who feel they can benefit from an unfettered portrayal of the current deplorable situation of the American health care sector. Other readers it will leave unsatisfied, because the authors – purposefully – fail to provide a balanced account of the pros and cons of both government regulation and privatisation. Despite this the volume offers a valuable contribution because the authors are brave enough to look into the future to speculate about where we are going and where we should be going.
American Health Care provides an interesting glance in the past, present and future of health care. It provides many insights in the American health care system that can also be applied on the other side of the ocean. And it succeeds in one of its main aims which is not to convince others of their rightness, but to fuel the debate on one of the most current political issues of our time.
