Field of medicine: History of medicine and public policy.

Format: Hardcover book.

Audience: Medical professionals and lay readers interested in the historical roots of contemporary dilemmas about health insurance, managed care, and the role of the federal government in U.S. health care.

Purpose: To trace the ways in which the middle-class demand for "high-tech" medical interventions has shaped the course of U.S. medicine in the 20th century, particularly with respect to public complacency about inequities in access to health care.

Content: The book's six sections, arranged chronologically, highlight turning points in medical technology, access to health services, and national versus private responsibility for the expenses of health care. Topics include the beginnings of Blue Cross in the 1930s, the provision of iron lungs in the 1940s and 1950s, the debates about Medicare in the early 1960s, the federal assumption of the costs of kidney dialysis in the early 1970s, the advent of the respirator during the last third of this century, and the Clinton health plan of the early 1990s.

Highlights: Rothman's argument is nuanced and historically informed; his writing is clear and straightforward; and his conclusion-that technology in U.S. medicine has been intimately connected with increasing inequality-is thought-provoking and unsettling.

Limitations: Specialists may wish for a more detailed account of physicians', not just patients', involvement with technologies.

Context: Like Paul Starr's Social Transformations of American Medicine (Basic Books, 1982), this book deals with the complex economic, political, and social interactions that have shaped U.S. medicine, but it does so in a succinct, cogent style accessible to a broad audience.

Reviewer: Conevery A. Bolton, Harvard University, Cambridge, Massachusetts.

Commentary: This book wields a sharp argument but no bombast. Although Rothman implicitly assails the failure of U.S. medicine to widen access to health care (especially technological interventions) to those below the "middle classes," he does so in measured arguments enlivened by dry wit. This book is well worth reading, even for those who ultimately disagree with its conclusions.