Government and Public Health in America

Government and Public Health in America

Ronald Hamowy

How involved should the government be in American healthcare? Ronald Hamowy argues that to answer this pressing question, we must understand the genesis of the five main federal agencies charged with responsibility for our health: the Public Health Service, the Food and Drug Administration, the Veterans Administration, the National Institutes of Health, and Medicare. In examining these, he traces the growth of federal influence from its tentative beginnings in 1798 through the ambitious infrastructures of today – and offers startling insights on the current debate.

Introduction

Ronald Hamowy

Subjects: economics and finance, health policy and economics, politics and public policy, public policy, social policy and sociology, economics of social policy, health policy and economics

Extract

Most Americans operate under the assumption that, unlike most other firstworld countries, the supply and distribution of health care in the United States is in private hands and that market forces play the principal role in determining the quantity and price of medical services. However, while this might have been true at the beginning of the twentieth century it is far from the case today. Indeed, even if one puts aside the sizeable number of laws and regulations governing the structure, qualifications, and powers of the medical profession, the sale and distribution of pharmaceuticals, and the conduct of hospitals, and considers only the proportion of dollar expenditures, more than 45 percent of all such disbursements were made by some political entity and of that amount over 70 percent were made by the federal government in 2001.1 The extent of federal involvement in the American health care system is truly massive. Besides annual expenditures of over half a trillion dollars,2 federal agencies provide some form of hospital and medical insurance to more than 83 000 000 Americans,3 operate a system of hospitals staffed by physicians, nurses, and technicians that treat a veteran population of almost half-amillion inpatients and 4.5 million outpatients, provide medical and hospital services for 1.6 million American Indians and Alaska natives, over 8 000 000 military personnel and mobilized reservists, together with their families and survivors, and over 166 000 federal prisoners. Indeed, despite its reputation as a center of free-market medicine, the United States has...