Beatrix Hoffman, “Health Care for Some: Rights and Rationing in the United States since 1930” (U of Chicago, 2012)

Disputes over the definitions or legality of ‘rights’ and ‘rationing’ in their various guises have animated much of the debate around the United States Affordable Care Act. Many legislators and vocal members of their constituency have strong convictions about the state of our current national health care system and where it is going. Far fewer, however, understand how our current state of affairs is the product of a quite recent and contingent history, which is precisely what Beatrix Hoffman‘s Health Care for Some: Rights and Rationing in the United States since 1930 (University of Chicago, 2012) sets out to explain. While Hoffman’s scope is the U.S. as a whole, she draws out the local consequences of sweeping wartime and post-war reform by focusing on various cities, notably Chicago. Using a framework that addresses the reciprocal roles of rights and rationing as articulated by physicians, policymakers, and patients throughout the latter part of the twentieth century, she presents a concise history that speaks to far greater questions.

Throughout Health Care for Some, we learn much about the institutional transformations of modern U.S. healthcare: how the expansive yet exclusive county hospital system was not inevitable but fell in line with other infrastructural imperatives, while war-wrecked European nations actually improved primary care coverage through austerity policies; how doctors increasingly struggled with poor state management and strictures that, despite being legally sanctioned, discouraged providing care to the most needy; how Medicare and Medicaid were motivated as much by the civil rights movement as arguments for dignity of old age as a social right. Importantly, the human dimensions of care are never hidden from sight, as Hoffman unravels narratives of entangled structures and subjectivities that evince the personal damage wrought by a system too diffuse to overhaul. Her book is an engaging, informative, and concise read, as capable of becoming a valuable reference as it is of fomenting thought and action.

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