Health Care for Some: Rights and Rationing in the United States Since 1930

Hoffman (The Wages of Sickness), associate professor of history at Northern Illinois University, uses a historical lens to “arrive at an honest understanding of rights and rationing in the [American] health care system.” She says that, though well-intentioned, the terms of the fiercely contested 2010 Patient Protection and Affordable Care Act—aka “Obamacare”—can be both misleading and difficult to understand. Hoffman traces the attempts, from presidents Franklin D. Roosevelt to Obama, to officially recognize universal health care as a right rather than a privilege for a moneyed few. By examining the demands and challenges of the Great Depression, WWII, the Korean conflict, and LBJ’s Great Society, she notes that the nation’s balking at equality of care is unique among industrialized countries because Americans fear socialized medicine’s rationing of care; they don’t see “the complex, sometimes hidden, and frequently unintended ways” a form of care rationing exists, with strict allocations based on race, region, income, and insurance coverage. She gives special emphasis to the longstanding battles over Medicare and Medicaid, noting their strengths and weaknesses, while outlining the positions of the programs’ supporters and opponents. Hoffman’s rational, plainspoken analysis succeeds in clarifying the discourse around a topic of pressing national importance, delineating partisans’ priorities and discarding the numerous distractions. (Oct.)