Jonathan Engel - Böcker

Written for nonexperts, this is a brisk, engaging history of American healthcare from the advent of Medicare and Medicaid in the 1960s to the impact of the Affordable Care Act in the 2010s. Step by step, Jonathan Engel shows how we arrived at our present convoluted situation, where generic drugs prices can jump 1,000 percent in a day and primary care physicians can lose 20 percent of their income at the stroke of a Congressional pen.Unaffordable covers, in a conversational style punctuated by apt examples, topics ranging from health insurance, pharmaceutical pricing, and physician training to health maintenance organizations and hospital networks. Along the way, Engel introduces approaches that other nations have taken in organizing and paying for healthcare and offers insights on ethical quandaries around end-of-life decisions, neonatal care, life-sustaining treatments, and the limits of our ability to define death. While describing the political origins of many of the federal and state laws that govern our healthcare system today, he never loses sight of the impact that healthcare delivery has on our wallets and on the balance sheets of hospitals, doctors' offices, government agencies, and private companies.

Poor People’s Medicine is a detailed history of Medicaid since its beginning in 1965. Federally aided and state-operated, Medicaid is the single most important source of medical care for the poorest citizens of the United States. From acute hospitalization to long-term nursing-home care, the nation’s Medicaid programs pay virtually the entire cost of physician treatment, medical equipment, and prescription pharmaceuticals for the millions of Americans who fall within government-mandated eligibility guidelines. The product of four decades of contention over the role of government in the provision of health care, some of today’s Medicaid programs are equal to private health plans in offering coordinated, high-quality medical care, while others offer little more than bare-bones coverage to their impoverished beneficiaries.Starting with a brief overview of the history of charity medical care, Jonathan Engel presents the debates surrounding Medicaid’s creation and the compromises struck to allow federal funding of the nascent programs. He traces the development of Medicaid through the decades, as various states attempted to both enlarge the programs and more finely tailor them to their intended targets. At the same time, he describes how these new programs affected existing institutions and initiatives such as public hospitals, community clinics, and private pro bono clinical efforts. Along the way, Engel recounts the many political battles waged over Medicaid, particularly in relation to larger discussions about comprehensive health care and social welfare reform. Poor People’s Medicine is an invaluable resource for understanding the evolution and present state of programs to deliver health care to America’s poor.

Transforming American Science documents the ways in which federal funds catalyzed or accelerated changes in both university culture and the broader system of American higher education during the post-World War II decades.The events of the book lie within the context of the Cold War, when pressure to maintain parity with the Soviet Union impelled more generous government spending and a willingness of some universities to reorient their missions in the service of country and of science. The book draws upon a substantial amount of archival research conducted in various university archives (MIT, Berkeley, Stanford) as well as at the Library of Congress, the National Archives, and various presidential libraries. Author Jonathan Engel considers the repurposing of the wartime Manhattan Engineering District and the Office of Naval Research to robust peacetime roles in supporting the nation's expanding research efforts, along with the birth of the National Science Foundation, space exploration, and atoms for peace among other topics.This volume is the perfect resource for all those interested in Cold War history and in the history of American science and technology policy.

Transforming American Science documents the ways in which federal funds catalyzed or accelerated changes in both university culture and the broader system of American higher education during the post-World War II decades.The events of the book lie within the context of the Cold War, when pressure to maintain parity with the Soviet Union impelled more generous government spending and a willingness of some universities to reorient their missions in the service of country and of science. The book draws upon a substantial amount of archival research conducted in various university archives (MIT, Berkeley, Stanford) as well as at the Library of Congress, the National Archives, and various presidential libraries. Author Jonathan Engel considers the repurposing of the wartime Manhattan Engineering District and the Office of Naval Research to robust peacetime roles in supporting the nation's expanding research efforts, along with the birth of the National Science Foundation, space exploration, and atoms for peace among other topics.This volume is the perfect resource for all those interested in Cold War history and in the history of American science and technology policy.

The diet and weight-loss industry is worth $66 billion – billion!! The estimated annual health care costs of obesity-related illness are 190 billion or nearly 21% of annual medical spending in the United States. But how did we get here? Is this a battle we can’t win? What changes need to be made in order to scale back the incidence of obesity in the US, and, indeed, around the world? Here, Jonathan Engel reviews the sources of the problem and offers the science behind our modern propensity toward obesity. He offers a plan for helping address the problem, but admits that it is, indeed, an uphill battle. Nevertheless, given the magnitude of the costs in years of life and vigor lost, it is a battle worth fighting. Fat Nation is a social history of obesity in the United States since the second World War. In confronting this familiar topic from a historical perspective, Jonathan Engel attempts to show that obesity is a symptom of complex changes that have transpired over the past half century to our food, our living habits, our life patterns, our built environments, and our social interactions. He offers readers solid grounding in the known science underlying obesity (genetic set points, complex endocrine feedback loops, neurochemical messengering) but then makes the novel argument that obesity is a result of the interaction of our genes with our environment. That is, our bodies have always been programmed to become obese, but until recently never had the opportunity to do so. Now, with cheap calories ubiquitous (particularly in the form of sucrose), unwalkable physical spaces, deteriorating rituals and norms surrounding eating, and the withering of cooking skills, nearly every American daily confronts the challenge of not putting on weight. Given the outcomes, though, for those who are obese, Engel encourages us to address the problems and offers suggestions to help remedy the problem.

Jonathan Engel traces the policy debates over healthcare delivery, and the ways of paying for it, that were conducted during the second quarter of the twentieth century in the United States. Examining the views advanced by doctors, including those unallied with the American Medical Association's position, as well as by ""reformers"" - academics, public health officers, philanthropists, foundation executives, and independent scholars - Engel displays how the discussion involved much more than the legislative efforts of New Deal Democrats regarding health insurance. Under discussion were group care, industrial health plans, nationalized hospitals, and public dispensaries. Engel's attention to the letters and other writings of key participants in the debates enriches his account, with the papers of Morris Fishbein, the president of the AMA, Michael Davis, a researcher for the Julius Rosenwald Foundation, and I. S. Falk, the research director for the Social Security Administration, adding concrete detail. His investigation demonstrates that physicians' reactions to legislative remedies were not monolithic. It also shows that foundation leaders were instrumental in enlisting organized labor, farmers, and liberal legislators in the improvement of the ""world's best"" medical care, and that the discussion was more than a debate between political foes. Participants in the debates discovered no simple solution to the challenges they explored, however, and their positions above all foreshadow the debate of succeeding decades.

The Union's forgotten mid-level officers and their commitment to the causeMore Important Than Good Generals is an in-depth study of the Army of the Tennessee's junior officers––the company and field grade lieutenants, captains, majors, lieutenant colonels, and colonels. While many studies have examined generals and common soldiers, Civil War armies' "middle management" has been largely ignored. Officers had a substantially different array of duties than the soldiers they commanded and the generals above them, resulting in a drastically different wartime experience. Moreover, it is not only Civil War officers who have been overlooked but also the army Grant and Sherman commanded––the Army of the Tennessee––despite the fact that it was one of the most victorious armies of the war.Pushing back against the commonly accepted narrative of disillusionment among officers, Engel concludes that the Army of the Tennessee's company and field grade officers endured the war's trials with their moral and political ideology intact. Further, rather than becoming indifferent to the Union cause, Engel argues that the reverse was often true: officers who started off racist or disinterested in the issue of enslavement became advocates of emancipation.Engagingly written and meticulously researched, More Important Than Good Generals is a lasting work of scholarship that will appeal to Civil War historians and general readers alike.