Remaking The American Patient

In a work that spans the twentieth century, Nancy Tomes questions the popular--and largely unexamined--idea that in order to get good health care, people must learn to shop for it. Remaking the American Patient explores the consequences of the consumer economy and American medicine having come of age at exactly the same time. Tracing the robust development of advertising, marketing, and public relations within the medical profession and the vast realm we now think of as "health care," Tomes considers what it means to be a "good" patient. As she shows, this history of the coevolution of medicine and consumer culture tells us much about our current predicament over health care in the United States. Understanding where the shopping model came from, why it was so long resisted in medicine, and why it finally triumphed in the late twentieth century helps explain why, despite striking changes that seem to empower patients, so many Americans remain unhappy and confused about their status as patients today.

In this age of multicultural democracy, the idea of assimilation--that the social distance separating immigrants and their children from the mainstream of American society closes over time--seems outdated and, in some forms, even offensive. But as Richard Alba and Victor Nee show in the first systematic treatment of assimilation since the mid-1960s, it continues to shape the immigrant experience, even though the geography of immigration has shifted from Europe to Asia, Africa, and Latin America. Institutional changes, from civil rights legislation to immigration law, have provided a more favorable environment for nonwhite immigrants and their children than in the past. Assimilation is still driven, in claim, by the decisions of immigrants and the second generation to improve their social and material circumstances in America. But they also show that immigrants, historically and today, have profoundly changed our mainstream society and culture in the process of becoming Americans. Surveying a variety of domains--language, socioeconomic attachments, residential patterns, and intermarriage--they demonstrate the continuing importance of assimilation in American life. And they predict that it will blur the boundaries among the major, racially defined populations, as nonwhites and Hispanics are increasingly incorporated into the mainstream.

In a compelling inquiry into public events ranging from the building of the Vietnam Veterans Memorial through ethnic community fairs to pioneer celebrations, John Bodnar explores the stories, ideas, and symbols behind American commemorations over the last century. Such forms of historical consciousness, he argues, do not necessarily preserve the past but rather address serious political matters in the present.--Publisher description.

At one time, universities educated new generations and were a source of social change. Today colleges and universities are less places of public purpose, than agencies of personal advantage. Remaking the American University provides a penetrating analysis of the ways market forces have shaped and distorted the behaviors, purposes, and ultimately the missions of universities and colleges over the past half-century. The authors describe how a competitive preoccupation with rankings and markets published by the media spawned an admissions arms race that drains institutional resources and energies. Equally revealing are the depictions of the ways faculty distance themselves from their universities with the resulting increase in the number of administrators, which contributes substantially to institutional costs. Other chapters focus on the impact of intercollegiate athletics on educational mission, even among selective institutions; on the unforeseen result of higher education's "outsourcing" a substantial share of the scholarly publication function to for-profit interests; and on the potentially dire consequences of today's zealous investments in e-learning. A central question extends through this series of explorations: Can universities and colleges today still choose to be places of public purpose? In the answers they provide, both sobering and enlightening, the authors underscore a consistent and powerful lesson-academic institutions cannot ignore the workings of the markets. The challenge ahead is to learn how to better use those markets to achieve public purposes.

Since the introduction of Medicare and Medicaid in 1965, the American health care system has steadily grown in size and complexity. Muriel R. Gillick takes readers on a narrative tour of American health care, incorporating the stories of older patients as they travel from the doctor's office to the hospital to the skilled nursing facility, and examining the influence of forces as diverse as pharmaceutical corporations, device manufacturers, and health insurance companies on their experience. A scholar who has practiced medicine for over thirty years, Gillick offers readers an informed and straightforward view of health care from the ground up, revealing that many crucial medical decisions are based not on what is best for the patient but rather on outside forces, sometimes to the detriment of patient health and quality of life. Gillick suggests a broadly imagined patient-centered reform of the health care system with Medicare as the engine of change, a transformation that would be mediated through accountability, cost-effectiveness, and culture change.

A New York Times bestseller/Washington Post Notable Book of 2017/NPR Best Books of 2017/Wall Street Journal Best Books of 2017 "This book will serve as the definitive guide to the past and future of health care in America.”—Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies and The Gene At a moment of drastic political upheaval, An American Sickness is a shocking investigation into our dysfunctional healthcare system - and offers practical solutions to its myriad problems. In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in their healthcare. Our politicians have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life; fatalism has set in. Very quickly Americans have been made to accept paying more for less. How did things get so bad so fast? Breaking down this monolithic business into the individual industries—the hospitals, doctors, insurance companies, and drug manufacturers—that together constitute our healthcare system, Rosenthal exposes the recent evolution of American medicine as never before. How did healthcare, the caring endeavor, become healthcare, the highly profitable industry? Hospital systems, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Patients receive bills in code, from entrepreneurial doctors they never even saw. The system is in tatters, but we can fight back. Dr. Elisabeth Rosenthal doesn't just explain the symptoms, she diagnoses and treats the disease itself. In clear and practical terms, she spells out exactly how to decode medical doublespeak, avoid the pitfalls of the pharmaceuticals racket, and get the care you and your family deserve. She takes you inside the doctor-patient relationship and to hospital C-suites, explaining step-by-step the workings of a system badly lacking transparency. This is about what we can do, as individual patients, both to navigate the maze that is American healthcare and also to demand far-reaching reform. An American Sickness is the frontline defense against a healthcare system that no longer has our well-being at heart.

Over the past three decades, the contours of American social, economic, and political life have changed dramatically. The post-war patterns of broadly distributed economic growth have given way to stark inequalities of income and wealth, the GOP and its allies have gained power and shifted U.S. politics rightward, and the role of government in the lives of Americans has changed fundamentally. Remaking America explores how these trends are related, investigating the complex interactions of economics, politics, and public policy. Remaking America explains how the broad restructuring of government policy has both reflected and propelled major shifts in the character of inequality and democracy in the United States. The contributors explore how recent political and policy changes affect not just the social standing of Americans but also the character of democratic citizenship in the United States today. Lawrence Jacobs shows how partisan politics, public opinion, and interest groups have shaped the evolution of Medicare, but also how Medicare itself restructured health politics in America. Kimberly Morgan explains how highly visible tax policies created an opportunity for conservatives to lead a grassroots tax revolt that ultimately eroded of the revenues needed for social-welfare programs. Deborah Stone explores how new policies have redefined participation in the labor force—as opposed to fulfilling family or civic obligations—as the central criterion of citizenship. Frances Fox Piven explains how low-income women remain creative and vital political actors in an era in which welfare programs increasingly subject them to stringent behavioral requirements and monitoring. Joshua Guetzkow and Bruce Western document the rise of mass incarceration in America and illuminate its unhealthy effects on state social-policy efforts and the civic status of African-American men. For many disadvantaged Americans who used to look to government as a source of opportunity and security, the state has become increasingly paternalistic and punitive. Far from standing alone, their experience reflects a broader set of political victories and policy revolutions that have fundamentally altered American democracy and society. Empirically grounded and theoretically informed, Remaking America connects the dots to provide insight into the remarkable social and political changes of the last three decades.

Publisher Description

One of New York Magazine's best books on Silicon Valley! The true, behind-the-scenes history of the people who built Silicon Valley and shaped Big Tech in America Long before Margaret O'Mara became one of our most consequential historians of the American-led digital revolution, she worked in the White House of Bill Clinton and Al Gore in the earliest days of the commercial Internet. There she saw firsthand how deeply intertwined Silicon Valley was with the federal government--and always had been--and how shallow the common understanding of the secrets of the Valley's success actually was. Now, after almost five years of pioneering research, O'Mara has produced the definitive history of Silicon Valley for our time, the story of mavericks and visionaries, but also of powerful institutions creating the framework for innovation, from the Pentagon to Stanford University. It is also a story of a community that started off remarkably homogeneous and tight-knit and stayed that way, and whose belief in its own mythology has deepened into a collective hubris that has led to astonishing triumphs as well as devastating second-order effects. Deploying a wonderfully rich and diverse cast of protagonists, from the justly famous to the unjustly obscure, across four generations of explosive growth in the Valley, from the forties to the present, O'Mara has wrestled one of the most fateful developments in modern American history into magnificent narrative form. She is on the ground with all of the key tech companies, chronicling the evolution in their offerings through each successive era, and she has a profound fingertip feel for the politics of the sector and its relation to the larger cultural narrative about tech as it has evolved over the years. Perhaps most impressive, O'Mara has penetrated the inner kingdom of tech venture capital firms, the insular and still remarkably old-boy world that became the cockpit of American capitalism and the crucible for bringing technological innovation to market, or not. The transformation of big tech into the engine room of the American economy and the nexus of so many of our hopes and dreams--and, increasingly, our nightmares--can be understood, in Margaret O'Mara's masterful hands, as the story of one California valley. As her majestic history makes clear, its fate is the fate of us all.

Alice Echols reveals the ways in which disco transformed popular music, propelling it into new sonic territory and influencing rap, techno, and trance. She probes the complex relationship between disco and the era's major movements: gay liberation, feminism, and African American rights. You won't say "disco sucks" as disco thumps back to life in this pulsating look at the culture and politics that gave rise to the music.