Book Two, Chapter Two: The Triumph of Accommodation

Since many of our conversations on the discussion forum have focused on the elements required to enact healthcare reform, this chapter was particularly interesting as it provides some history on what societal context gave rise to previous healthcare reforms. Starr talks about how the Great Depression was a huge impetus for the rise of insurance, particularly the rise of Blue Cross and Blue Shield, as well as a variety of indemnity plans. While we are not in a true Depression, we are in a recession and fears about the future are high. I wonder if the combination of economic insecurity and new leadership might be key ingredients to true reform.

I have also been struck throughout the book with the characterization of the AMA. While Starr fairly explains their intent, the effect of their policies seems to do harm, rather than avoid it. To claim total control over medicine is not only impractical, it fails to recognize the complex requirements of a healthcare system. While the relationships between the AMA and rest of the healthcare system appear to be less antagonistic now, traces of this former rift are still apparent. Healthcare providers complain that administrators don’t understand that of the floor staff while administrators hold that providers miss the big picture. If we seek to move towards reform, it is necessary that we move beyond turf battles to collaboration.

Finally, I thought it was interesting how the UMWA created an issue that John Kingdon would call “in-waiting” for a window of opportunity. Lewis carefully build stakeholder support and used various agenda setting opportunities to achieve his goal of insurance for miners. While he initially met opposition, he used the window of opportunity created by the 1947 Interior report to activate the miner’s funds. It is interesting to consider that many of our health policy issues are like the miner’s funds; they are formed and just floating along, waiting for the right opportunity.