During most of this century, American health policy has emphasized caring for acute conditions rather than preventing and managing chronic illness—even though chronic illness has caused most sickness and death since the 1920s. In this provocative and wide-ranging book, Daniel Fox explains why this has been so and offers a forceful argument for fundamental change in national health care priorities.

Fox discusses how ideas about illness and health care, as well as the power of special interest groups, have shaped the ways in which Americans have treated illness. Those who make health policy decisions have increased support for hospitals, physicians, and medical research, believing that people then would become healthier. This position, implemented at considerable cost, has not adequately taken into account the growing burden of chronic disabling illness. While decision makers may have defined chronic disease as a high priority in research, they have not given it such a priority in the financing of health services.

The increasing burden of chronic illness is critical. Fox suggests ways to solve this problem without increasing the already high cost of health care—but he does not underestimate the difficulties in such a strategy. Advocating the redistribution of resources within hospital and medical services, he targets those that are redundant or marginally effective.

There could be no more timely subject today than American health care. And Daniel Fox is uniquely able to address its problems. A historian of medicine, with knowledge of how hospitals and physicians behave and how health policy is made at government levels, he has extensively researched published and unpublished documents on health care. What he proposes could profoundly affect all Americans.

Daniel M. Fox is President of the Milbank Memorial Fund. His many books include Health Politics, Health Policies: The Experience of Britain and America, 1911-1965 (1986) and, as coeditor, AIDS: The Making of a Chronic Disease (California, 1992), and AIDS: The Burdens of History (California, 1988).

"Excellent policy analysis and prescription, which is extensively researched and well written and should serve as an important resource in on-going policy discussions."—Bernard S. Bloom, Journal of the American Medical Association

"An astute, insider's view of health politics, past and present."—Steve Heilig, San Francisco Chronicle Review

"Provide[s] perspective on the issue of long-term care."—Joseph P. Newhouse, New York Times Book Review

"In this timely and persuasive appeal for revision of U.S. health care funding priorities, Fox contends that, as a result of 19th-century advances in bacteriology research, largely concerned with infectious diseases, resources are devoted to them rather than to the prevention of—and care for those who have—chronic ailments and disabilities."—Publishers Weekly

"Fox uses AIDS, first seen as an acute disease and later as chronic, as a striking illustration of the political acceptability of funding the former kind of disease but not the latter. He sees a redistribution of health care funds and the training of more primary care physicians as the major steps toward effective change. Drawing from his long and varied experience as medical historian and administrator, Fox finally suggests practical means toward those ends."—Booklist