Recent commentary on the health care scene in the U.S. has moved increasingly toward explanations of why little or no change has occurred despite many declarations of "crisis." From Alford's (1975) elitist analysis in Health Care Politics to Navarro's (1976) marxist analysis in Medicine Under Capitalism, critics in and out of the social sciences have tried to make sense of the array of current problems and the apparent lack of response to or change in them. These analyses are in striking contrast to earlier commentaries (e.g., Schwartz, 1971; Garfield, 1970; Anderson, 1972; Citizens Board, 1972) which, while highly critical of then current health care arrangements, foresaw the potential for change within the system and often made recommendations for potential solutions. If these earlier analyses might be said to have been characterized by an unwarranted optimism regarding the potential for change, the more recent analyses have more than counter-balanced that orientation with an overwhelming skepticism regarding any significant change, short of major societal restructuring. Health care arrangements are seen in these analyses as rooted in the more basic distribution of power and control in the U.S. (from an elitist perspective), or in the fundamental economic structure of the society itself (from a marxist perspective). Thus no significant change should have been, nor can be expected.

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