Technology, American Democracy and Health Care

British Journal of Political Science

Volumn 27, Issue 4, 1997, Pages 573-594

  Moran, Michael ^a   Alexander, Elizabeth ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

EID: 0031506066     PISSN: 00071234     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0007123497000276     Document Type: Article

References (69)

1. The figures for 1960-90 for the United States and Britain are in OECD, OECD Health Systems: Facts and Trends 1960-1991 (Paris: OECD, 1993), vol. 1, p.18. The 1993 figure for the United States is from Katherine R. Levit, Cathy A. Cowan, Helen C. Lazenby, Patricia A. McDonnell, Arthur L. Sensenig, Jean M. Stiller and Darleen K. Won, 'National Health Spending Trends, 1960-1993', Health Affairs, 13, No. 5 (1994), 14-31, p. 16.
2. The figures for 1960-90 for the United States and Britain are in OECD, OECD Health Systems: Facts and Trends 1960-1991 (Paris: OECD, 1993), vol. 1, p.18. The 1993 figure for the United States is from Katherine R. Levit, Cathy A. Cowan, Helen C. Lazenby, Patricia A. McDonnell, Arthur L. Sensenig, Jean M. Stiller and Darleen K. Won, 'National Health Spending Trends, 1960-1993', Health Affairs, 13, No. 5 (1994), 14-31, p. 16.
3. The issues are examined in Burton A. Weisbrod, 'The Health Care Quadrilemma: An Essay on Technological Change, Insurance, Quality of Care, and Cost Containment', Journal of Economic Literature, 29 (1991), 523-52.
4. We draw here on Annetine Gelijns and Nathan Rosenberg, 'The Dynamics of Technological Change in Medicine', Health Affairs, 13, No. 3 (1994), 28-46.
5. Lawrence R. Jacobs, 'Politics of America's Supply State: Health Reform and Technology', Health Affairs, 14, No. 2 (1995), 143-57, pp. 144 and 145.
6. Klim McPherson, 'International Variations in Different Medical Practices' in Health Care Systems In Transition: The Search for Efficiency (Paris: OECD, 1990), pp. 17-28.
7. Weisbrod, 'The Health Care Quadrilemma', p. 526.
8. Richard A. Rettig, 'Medical Innovation Duels Cost Containment', Health Affairs, 13, No. 3 (1994), 7-27, p. 11. Strictly, a lower rate of investment or diffusion does not tell us that inflationary effects are lower. We know anecdotally that some innovations are cost reducing; the crucial question is therefore not the level of innovation or diffusion, but the extent to which the technology employed is cost inflating or cost reducing. It is only in the case of the United States that we have a good body of evidence demonstrating that it is the former. And we only have this because technology assessment in health care is even less highly developed in Europe than in the United States.
9. Weisbrod, 'The Health Care Quadrilemma', p. 524.
10. Edgar A. Peden and Mark S. Freeland, 'A Historical Analysis of Medical Spending Growth, 1960-93', Health Affairs, 14, No. 2 (1995), 235-47, p. 235.
11. Susan Bartlett Foote, Managing the Medical Arms Race: Public Policy and Medical Device Innovation (Berkeley: University of California Press, 1992), p. 179.
12. Malcolm C. Brown, Health Economics and Policy: Problems and Prescriptions (Toronto: McLelland and Stewart, 1991), p. 169.
13. The analytical argument for this threefold division is elaborated in Michael Moran, 'Three Faces of the Health Care State', Journal of Health Politics, Policy and Law, 20 (1995), 767-81.
14. Foote, Managing the Medical Arms Race, pp. 9-15 has a useful discussion. 'Scientific medicine' is a species of applied science, and as such raises difficult questions about the connection between 'science' and 'technology' - but these questions, though important, are not of concern in this article.
15. For the history of the transformation, see Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), pp. 79-144.
16. Starr, Social Transformation, p. 4.
17. Stuart S. Blume, Insight and Industry: On the Dynamics of Technological Change in Medicine (Cambridge, Mass: MIT Press, 1992), p. 227.
18. Joseph D. Bronzino, Vincent L. Smith and Maurice L. Wade, Medical Technology and Society: An Interdisciplinary Perspective (Cambridge: Mass., MIT Press, 1990), p. 12.
19. Blume, Insight and Industry, p. 260.
20. Blume, Insight and Industry, p. 113.
21. Gerard Anderson, Earl Steinberg and Robert Heyssel, 'The Pivotal Role of the Academic Health Center', Health Affairs, 13 (1994), 146-58, pp. 151-2.
22. Stanley Joel Reiser, Medicine and the Reign of Technology (Cambridge: Cambridge University Press, 1978).
23. Alonzo Plough, Borrowed Time: Artificial Organs and the Politics of Extending Lives (Philadephia: Temple University Press, 1986), esp. p. 24 and pp. 115-29.
24. Blume, Insight and Industry, p. 258.
25. I. E. A. Wickham, 'An Introduction to Minimally Invasive Therapy', Health Policy, 23 (1993), 7-15, pp. 10-11.
26. These examples are taken from H. David Banta and Hindrik Vondeling, 'Diffusion of Minimally Invasive Therapy in Europe', Health Policy, 23 (1993), 125-33; and Wickham, 'An Introduction to Minimally Invasive Therapy'.
27. These examples are taken from H. David Banta and Hindrik Vondeling, 'Diffusion of Minimally Invasive Therapy in Europe', Health Policy, 23 (1993), 125-33; and Wickham, 'An Introduction to Minimally Invasive Therapy'.
28. For a study of this process in the United States, see Peter Temin, Taking Your Medicine: Drug Regulation in the United States (Cambridge, Mass: Harvard University Press, 1980), pp. 46-51.
29. 'America's drug industry', The Economist, 5 December 1992, p. 101.
30. Plough, Borrowed Time, p. 136.
31. Temin, Taking Your Medicine, p. 58.
32. Temin, Taking Your Medicine, pp. 64-6, on the wartime development of penicillin.
33. And neither was it solely an American or a mid-century phenomenon: for the interconnections between industrial strategy, science and a military state in Wilhelmine Germany, see Jonathan Liebenau, 'Paul Ehrlich as a Commercial Scientist and Research Administrator', Medical History, 34 (1990), 65-78.
34. See the table of firms in Vicente Navarro, Dangerous To Your Health: Capitalism in Health Care (New York: Monthly Review Press, 1993), p. 26.
35. Manuel Trajtenberg, Economic Analysis of Product Innovation: The Case of CT Scanners (Cambridge, Mass: Harvard University Press, 1990), p. 2.
36. The quotation, and the evidence supporting this passage, is from Richard A. Merrill, 'Regulation of Drugs and Devices: An Evolution', Health Affairs, 13 (1994), 47-69, p. 55.
37. Foote, Managing the Medical Arms Race, p. 10.
38. Some of consequences for the hospital industry are examined in Patricia J. Arnold, 'The Invisible Hand in Health Care: The Rise of Financial Markets in the US Hospital Industry', in John L. Campbell, J. Rogers Hollingsworth and Leon N. Lindberg, eds, Governance of the American Economy (Cambridge: Cambridge University Press, 1991), pp. 293-316.
39. Gail Wilensky, 'Incremental Health System Reform: Where Medicare Fits In', Health Affairs, 14(1995), 173-181, p. 173.
40. Foote, Managing the Medical Arms Race, p. 85.
41. This key Reaganite reform is described in William P. Brandon, Two Kinds of Conservatism in US Health Policy: The Reagan Record', in Christa Altenstetter and Stuart C. Heywood, eds, Comparative Health Policy and the New Right: From Rhetoric to Reality (Basingstoke, Hants: Macmillan, 1991), pp. 165-206.
42. Trajtenberg, Economic Analysis of Product Innovation, pp. 45-9.
43. H. D. Banta, 'The Diffusion of the Computed Tomography (CT) Scanner in the United States', International Journal of Health Services, 10 (1980), 251-69, p. 263.
44. This paragraph relies on Foote, Managing the Medical Arms Race, pp. 179-90.
45. Mark A. Peterson, 'Political Influence in the 1990s: From Iron Triangles to Policy Networks', Journal of Health Politics, Policy and Law, 18 (1993), 397-438; Peterson, 'Institutional Change and Health Politics of the 1990s', American Behavioral Scientist, 36 (1993), 782-801; Jack L. Walker, Mobilizing Interest Groups in America: Patrons, Professions and Social Movements (Ann Arbor: Michigan University Press, 1991), esp. pp. 9-11, 49 and 53.
46. Mark A. Peterson, 'Political Influence in the 1990s: From Iron Triangles to Policy Networks', Journal of Health Politics, Policy and Law, 18 (1993), 397-438; Peterson, 'Institutional Change and Health Politics of the 1990s', American Behavioral Scientist, 36 (1993), 782-801; Jack L. Walker, Mobilizing Interest Groups in America: Patrons, Professions and Social Movements (Ann Arbor: Michigan University Press, 1991), esp. pp. 9-11, 49 and 53.
47. Mark A. Peterson, 'Political Influence in the 1990s: From Iron Triangles to Policy Networks', Journal of Health Politics, Policy and Law, 18 (1993), 397-438; Peterson, 'Institutional Change and Health Politics of the 1990s', American Behavioral Scientist, 36 (1993), 782-801; Jack L. Walker, Mobilizing Interest Groups in America: Patrons, Professions and Social Movements (Ann Arbor: Michigan University Press, 1991), esp. pp. 9-11, 49 and 53.
48. On the displacement of herbal medicine, see Ronald L. Caplan, 'The Commodification of American Health Care', Social Science and Medicine, 28 (1989), 1139-48; on chiropractic, see Steven C. Martin, 'Chiropractic and the Social Context of Medical Technology, 1895-1925', Technology and Culture, 34 (1993), 809-34. Against the complexity and physical alienation associated with instrumental exploration of the body, chiropractic stressed simplicity and direct physical manipulation; the therapy was, therefore, plunged into a great crisis by the attempt of some practitioners to introduce a technological innovation - a machine to measure the temperature of the spine.
49. On the displacement of herbal medicine, see Ronald L. Caplan, 'The Commodification of American Health Care', Social Science and Medicine, 28 (1989), 1139-48; on chiropractic, see Steven C. Martin, 'Chiropractic and the Social Context of Medical Technology, 1895-1925', Technology and Culture, 34 (1993), 809-34. Against the complexity and physical alienation associated with instrumental exploration of the body, chiropractic stressed simplicity and direct physical manipulation; the therapy was, therefore, plunged into a great crisis by the attempt of some practitioners to introduce a technological innovation - a machine to measure the temperature of the spine.
50. Starr, Social Transformation of American Medicine, p. 124.
51. Stevens, In Sickness and in Wealth, p. 282.
52. Stephen P. Strickland, Politics, Science and Dread Disease: A Short of History of United States Medical Policy (Cambridge, Mass: Harvard University Press, 1972), on cancer, and p. 265 for President Nixon's remark; on the artificial heart, see Thomas A. Preston, 'The Artificial Heart', in Diana B. Dutton, Worse Than the Disease: Pitfalls of Medical Progress (Cambridge: Cambridge University Press, 1988), pp. 91-126.
53. Stephen P. Strickland, Politics, Science and Dread Disease: A Short of History of United States Medical Policy (Cambridge, Mass: Harvard University Press, 1972), on cancer, and p. 265 for President Nixon's remark; on the artificial heart, see Thomas A. Preston, 'The Artificial Heart', in Diana B. Dutton, Worse Than the Disease: Pitfalls of Medical Progress (Cambridge: Cambridge University Press, 1988), pp. 91-126.
54. Stephen P. Strickland, Politics, Science and Dread Disease: A Short of History of United States Medical Policy (Cambridge, Mass: Harvard University Press, 1972), on cancer, and p. 265 for President Nixon's remark; on the artificial heart, see Thomas A. Preston, 'The Artificial Heart', in Diana B. Dutton, Worse Than the Disease: Pitfalls of Medical Progress (Cambridge: Cambridge University Press, 1988), pp. 91-126.
55. Rettig, 'Medical Innovation Duels Cost Containment', p. 19.
56. Preston, 'The Artificial Heart'.
57. Strickland, Politics, Science, and Dread Disease, pp. 209-10, sums up these forces.
58. On the FDA, see Merrill, 'Regulation of Drugs and Devices', and Temin, Taking Your Medicine, esp. pp. 18-57.
59. On the FDA, see Merrill, 'Regulation of Drugs and Devices', and Temin, Taking Your Medicine, esp. pp. 18-57.
60. Rettig, 'Medical Innovation Duels Cost Containment', p. 19.
61. Rettig, 'Medical Innovation Duels Cost Containment', p. 20.
62. See the table in Navarro, Dangerous To Your Health, p. 34.
63. See M. F. Drummond, ed., Economic Appraisal of Health Technology in the European Community (Oxford: Oxford University Press, 1987).
64. The intellectually underdeveloped character of assessment is a main theme of John B. McKinlay, 'From "Promising Report" to "Standard Procedure": Seven Stages in the Career of a Medical Innovation', Milbank Memorial Fund Quarterly, 59 (1981), 374-411.
65. David F. Durenburger and Susan Bartlett Foote, 'Technology and Health Reform: A Legislative Perspective', Health Affairs, 13 (1994), 197-214, p. 202.
66. Rettig, 'Medical Innovation Duels Cost Containment', p. 16.
67. Durenburger and Foote, 'Technology and Health Reform', p. 202.
68. Alan M. Garber, 'Can Technology Assessment Control Health Spending?', Health Affairs, 13 (1994), 114-26, at p. 124.
69. The quotation, and the two examples, are from Rettig, 'Medical Innovation Duels Cost Containment', pp. 20-1.