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1、chapter?7HealthhealthcareanditsreformconstituteoneofthemostcomplicatedyetatthesametimecriticalsocialpolicyissuesfacingtheUnitedStatestoday.Tobegin,weacknowledgethat,althougheveryonewantsit,healthisdif-ficulttodefine.Mostholditassomethingmorethantheabsenceofdisease.TheUnitedStatesspendssome17pe
2、rcentofitsgrossdomesticproductattemptingtoachieveit.In2010thecombinationofMedicare,Medicaid,andrelatedchildren’shealthcareaccountedformorethan20percentofallfederalspending—morethanSocialSecurityordefense.Medicarecostsapproximated521billiondollarsandareexpectedtogrowatanannualrateof5.6percentth
3、rough2021.Thenumberofbeneficiariesisexpectedtogrowfrom38.5millionpeopleto64.9millionduringthesametimeperiod(2010–2021).1Therearevariousproxiesforhealth—forexample,lifeex-pectancyandinfantmortalityrate.Thelocationofdiseasewithinourbod-iesissurprisinglynew,andthediscoveryofcausesfordiseasesevenn
4、ewer.2Newestofallistheabilitytodosomethingaboutdisease,eventocureit.GeorgeWashingtonwasnotkilledbyhisseriousinfectiousdiseasebutbytheheroictherapyhereceived:bleeding.IfStalinhadtobeabitimprudenttofeardoctors,Rousseau’sinjunctiontoavoidthemwas,atleastinretrospect,altogethersane.Withthehumangeno
5、meprojectaheadofschedule,medicinehasforgedapactofcriticalimportance,firstwithcare-fulsystematicobservationandlater,increasingly,withscience.Allthisistosaythatmedicinehaschanged,iscurrentlychanging,andwillchangeinthefuture.Atleastfornowandinthefuture,wecansubstitutetheword“progress”for“change.”
6、health121Yetmedicalprogressandsocialchangediverge.Barringsignificantchangesinsociety,theywilldivergefurther.Associalchangeincreasinglytiltssocietytowardthebenefitsofhaves,thedivergencebetweenmedicalandsocialchangewillnotbetothebenefitofhave-nots.Thepatternsexisttoday,withwhiteslivingalmostadec
7、adelongerthanAfricanAmericans,theUnitedStatesbeingaworldmeccaforthebestmedicinefortherich,slightlymorethanfiftymillionpeopleintheUnitedStatesuninsured,poorareasbeingpoorlyserved,developingnationsplaguedbydiseaseslongban-ishedfromdevelop
