Book Review

History and Health Policy in the United States: Putting the Past Back in

N Engl J Med 2007; 356:1486April 5, 2007

Article

History and Health Policy in the United States: Putting the Past Back in
(Critical Issues in Health and Medicine.) Edited by Rosemary A. Stevens, Charles E. Rosenberg, and Lawton R. Burns. 364 pp. New Brunswick, NJ, Rutgers University Press, 2006. $68 (cloth); $24.95 (paper). ISBN: 978-0-8135-3837-2 (cloth); 978-0-8135-3838-9 (paper).

In this book, a distinguished group of historians and social scientists have written 13 chapters organized around the idea that history can, and should, inform contemporary decisions on health policy. In the introduction, Rosemary Stevens underscores the power of historical writing, which both creates a narrative that defines the way we collectively see the world and allows us to consider a wider range of possibilities for today's health policy options.

The book acknowledges the complexity of health policy in its inclusion of a range of topics and analytic approaches. Robert Cook-Deegan and Michael McGeary describe the development of the National Institutes of Health. Colleen Grogan documents the role of Medicaid in the rise of institutions for long-term care. Lawton Burns and Alexandra Burns use a historical case study, the bankruptcy of the Allegheny Health, Education, and Research Foundation, to suggest that a top-down governmental approach interferes with the ability of local decision makers to respond to unique regional circumstances. Nancy Tomes and Amy Fairchild, in separate chapters, describe the changing meanings of “health consumer” and “privacy” over the course of a century and discuss the current definitions. Lawrence Brown describes recurrent themes in recent policy to explain the paradoxical expansion of U.S. health programs in a society with an aversion to “big government.” Charles Rosenberg characterizes health policy history as the continuing struggle between the tensions of power, conflict, values, and systems.

The span of the book is admirable, but it cannot cover the whole of health policy. It is not, for instance, a “history from below” — we are left to wonder whether the voice of the uninsured will change future health policy. But the stories that are included in the book suggest the potential of health policy history to inform us as we move forward on priorities not emphasized in the book, such as disparities in health and in care.

The editors have put together an all-star cast. We come expecting, and are given, strong, expert solo performances from the social sciences, law, and history. The lessons implicit in these chapters invite us to use past evidence to test our mental models, while the lens of historical perspective forces us to examine our theoretical assumptions and to explore a larger range of possible alternatives.

Constance Wei-Fang Liu
Duncan B. Neuhauser, Ph.D.
Case Western Reserve University, Cleveland, OH 44106
constance.liu@case.edu