Health Care Politics, Policy, Distributive Justice: The Ironic Triumph  by Robert P. Rhodes, State University of New York Press, Albany, 1992

Review by Del Meyer, MD

Dr. Rhodes states in his preface that health care providers think of medicine in scientific and technical terms totally removed from power and influence.  Harold Lasswell’s famous aphorism is that politics is the study of “Who gets what, when, and how.”  Students of politics are interested in describing and evaluating how health care goods and services are created, administered, and distributed as indications of power and influence.  Rhodes focuses on and tries to illustrate the distribution of power and influence in health care.  How do we distribute justice?  Who ought to receive more or less health care?  How should we decide these distributions?  Most of health care politics is routine conflict over who gets what, when, and how.  Most conflict is ironic.  When professional associations such as the AMA succeed at raising education standards for members, they also produce increased specialization and specialty organizations that conflict with and eventually weaken the influence of the parent organization.

Rhodes points out we have a medical delivery system second to none in the world; that includes, with some glaring exceptions, health care for the poor.  We have extended life with medical technology and pharmaceuticals.  Medical Science stands triumphant in our generation.  Yet we are uneasy about the fact that it consumes 12 percent of our GNP, and 10 percent of our health care budget is spent on the process of dying.  Yet to cut back on health care costs seems to threaten the well-being of those who most need it: the elderly, the rural poor, those suffering from AIDS, needing transplants, or dialysis.

Clearly these are medical and political and moral and justice questions.  Rhodes gives us his perspective of this as he proceeds through modern miracles, hard choices, health care politics, and questions where justice is in the insurance crises.  He literally shows how political decisions allocate life or death, a discussion generally missing in the public policy debate.

The national debate may be in remission until after the November elections.  The California debate is in high gear for the same elections.  We must individually and collectively continue the debate on behalf of those we serve: our patients in Sacramento, whether as citizens of the USA or residents of California.  If we make our decision based on our exasperation with the current system, we may have lost an opportunity for a continuing doctor/patient relationship without third-party interference or control – something no other people on earth have achieved.  It can only be achieved with insurance reform, not with bureaucratic control.  If we go the way the other nations did with compulsory government-controlled health care, our people will lose what they so desperately fought for.  And it was our profession that lost the battle for them.  We and they deserve better.  They (our patients) have no other leadership.  We cannot give up the fight (for them).