Wednesday, December 24, 2008


It is an interesting time to be in Washington D.C., particularly working on issues of health and health care. I look forward to seeing how things play out with so much talk of health reform going around. I recently picked up a few books and reread some old ones that I think help create a good foundation of knowledge about the challenges and possibilities for health reforms in the coming years. I wanted to highlight four that I think are great reads:

The first and probably most approachable book is Critical: What We Can Do About the Health-Care Crisis by Senator Tom Daschle (with Greenberger and Lambrew). This book is a good primer for the upcoming health care debate, and is extremely timely (making it somewhat hard to find at a bookstore...) given that Daschle will likely be the next head of the Department of Health and Human Services. Daschle, an experienced former Senator, brings a unique perspective to the discussion and highlights the plight of real Americans using poignant and illuminating examples from people he has interacted with during his long career of public service. The book does a good job providing a clear overview of what must be taken into account and what reforms should be made. It is written in a very engaging manner and would be a great read for anyone even vaguely interested in one of the possibly largest overhauls to the U.S. government in history.

The second book is Health Care at Risk: A Critique of the Consumer-Driven Movement by Timothy Jost. Jost is a law professor but the book reads more like a thriller (well, maybe not for most people...). He paints a clear picture of the rise of the consumer-driven health movement and highlights its intellectual as well as political origins. While it would seem that consumer-driven health would be the focus of the book, in fact, that is only one part of the overall story. Jost constructs the most clear and concise narrative I have found about the rise of the current U.S. health care system and how truly exceptional (not in a good way, by most accounts) the American system is. He does a good job identifying the common conceptions that people have about health care and the possible solutions. His analysis questions many of these assumptions and forces us to think critically about the goals of health care and what those goals would mean for reforms.

The third book is Governing Health: The Politics of Health Policy by Weissert and Weissert. The book is the best source I have seen that lays out the different actors and interests that play a role in the health care debate. Each of the key players (Congress, the President, interest groups, etc.) is explored at length, including their often contradictory and nuanced stances and perceived interests. Written by two political scientists, the book provides an excellent overview of the factors that are likely to come into play during any health care debate, particularly one that would entail wide-ranging reforms to the system. The actual policy process is also highlighted, something that is often discounted when people talk about what should be done when it comes to health. Taking into account the feasibility of particular reforms will be key for the new administration and any advocates of reform.

The final book is Why Are Some People Health and Others Not? The Determinants of Health of Populations, edited by Evans, Barer, and Marmor. This classic book is a personal favorite. It expands the notions of health away from just health care by examining the importance of how society is structured and its implications for health. The book highlights growing congruence among a number of fields that identify health issues that cannot be explained simply by differences in care or sanitation or wealth. It highlights the importance of factors like hierarchy, genetics, and structural issues that play an important role in determining not just health outcomes but also opportunities for care and even understandings of what it is to be sick. Many of the ideas underlying this book played a key role in my graduate work.

If there are any books that you have found helpful to understand health or health care, please let me know as I am always looking for new sources on the subject.

Saturday, December 6, 2008

Hard To Imagine How The NRA Can Spin This

A recent study which was underwritten by more than 300 U.S. mayors has uncovered some extremely damning evidence about the link between lax gun laws and legal guns ending up being used in crimes. The study makes clear that 10 states with lax gun laws are responsible for over 50% of guns used in crimes across the U.S. This number should be staggering and the repercussions swift. This sort of dangerous funneling of weapons to be used in crimes cannot be allowed to continue. While people will continue to argue that it is not the guns that commit the crimes, it is clear that access to guns is providing the ability to carry out many crimes. It is hard to imagine how anyone reading the report could come to the conclusion that gun control does not have a positive effect on reducing the amount of guns in the hands of criminals. Particularly deplorable was the cover-up pushed by the industry to keep this data from seeing the light of day. To know that such data exists and to try to censor it is despicable and calls into question how dedicated to safety those involved really are.

It isn't just purchasing guns intended for use in crimes that is making headlines. In the same days as the above-mentioned report was released, this story came out as well. I cannot imagine how horrible all those involved must be feeling at this moment. It is difficult to imagine such a senseless thing, all because a weapon was being treated as a source of entertainment. Why an eight year-old would be allowed to fire such a deadly weapon is beyond me. I hope people learn to respect the dangers that guns pose and accept that they must be regulated for public safety. Together these two articles highlight what many researchers in a variety of fields (including public health, criminology, sociology, economics, and others) have found, that guns must be regulated and that protections must be in place to keep guns out of the wrong hands. Clearly many states are failing on this issue and must be brought to task.