Journal of urban health : bulletin of the New York Academy of Medicine
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Historical Article
Crisis, leadership, consensus: the past and future federal role in health.
This paper touches on patterns of federal government involvement in the health sector since the late 18th century to the present and speculates on its role in the early decades of the 21st century. Throughout the history of the US, government involvement in the health sector came only in the face of crisis, only when there was widespread consensus, and only through sustained leadership. One of the first health-related acts of Congress came about as a matter of interstate commerce regarding the dilemma as to what to do about treating merchant seamen who had no affiliation with any state. ⋯ Despite an economic boom, 1 million Americans lose their health insurance each year, with 41 million Americans, or 15% of the population, lacking coverage. Private premiums are going up again as federal programs are capped and the lack of a federal framework for quality assurance leads to growing problems of access and quality that will need to be addressed as we enter the 21st century. What role will government play?
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To ask whether social medicine still matters may seem to be in poor taste at a symposium to honor Martin Cherkasky, but social medicine has always had the courage to take on difficult questions. There is all the more reason to do so when its legitimacy is challenged. The extraordinary findings emerging from the human genome project will revolutionize diagnostic and therapeutic methods in medicine. ⋯ It is a moral indictment of the US that ours is the only industrialized society without universal health care coverage. In educating the American public about the social determinants of health, a goal Martin Cherkasky championed, the very power of the new molecular biology will help make our case. Social medicine is alive and well.