UTA professor's book explains complex world of public health, individual medical services


Credit: UT Arlington

A book from a UTA associate professor explains why the United States has the health system it has.

Daniel Sledge, associate professor of political science at The University of Texas at Arlington, wrote Health Divided: Public Health and Individual Medicine in the Making of the Modern American State, published by University Press of Kansas.

The book explains why the federal government emerged as a central force in promoting public health work, through the CDC, while engaging in the promotion of individual medical services on a patchwork basis. Sledge said there has been a great deal continuity in the American health care system since the 1960s, when the creation of Medicare and Medicaid helped to lock in a system underpinned by employer-sponsored health insurance.

"Under slightly different circumstances, we could have ended up with far more extensive federal government involvement in providing access to health services," said Sledge, who specializes in health policy and politics at UTA. "Beyond this, individual medical services might have been more closely integrated with preventive and public health efforts."

In addition, Health Divided portrays Obamacare as consistent with long-standing patterns in American health politics, with state-based exchanges and Medicaid expansion layered on top of the existing health care system.

"Future changes will likely remain consistent with these patterns, rather than overturning existing institutions," Sledge said. "Going forward, we would expect effective change to occur within the framework of employer-sponsored health insurance, Medicare, Medicaid, and the state-based exchanges. Reforms that seek to upend these arrangements are highly unlikely to make it through Congress."

Sledge said that many attempts at national health insurance have failed because the melding of health policy with individual medicine have not been property understood.

"The book shows how the distinct politics of the formative years of health policy – and the presence of debilitating diseases in the American South – led to outcomes that have fundamentally shaped modern policies and disputes," Sledge said. "Until the end of the 19th century, health care in the United States was seen as a local issue with the sole exception being the government's role in providing care to seamen and immigrants."

Health Divided argues that the health problems that plagued the American South in the early 20th century, from malaria to hookworm and pellagra, along with the political power of the southern Democrats during the New Deal, fueled the emergence of national intervention in public health work.

At the same time, divisions among policymakers, as well as the resistance of the American Medical Association, led to federal inaction in the realm of individual medical services, which set the stage for the growth of employer-sponsored health insurance.

"This is so timely as Congress struggles with health care, how to make it more accessible and affordable," Elisabeth Cawthon, interim dean of the College of Liberal Arts. "Dr. Sledge has an extensive research background in health care and health policy. Exploring the history behind its failure, and tracing the complicated links between public health and national health policy, Health Divided provides a valuable new perspective on the foundations of America's disjointed health care system."

The book is available on Amazon and at Barnes and Noble.


About The University of Texas at Arlington

The University of Texas at Arlington is a Carnegie Research-1 "highest research activity" institution. With a projected global enrollment of close to 57,000, UTA is one of the largest institutions in the state of Texas. Guided by its Strategic Plan 2020 Bold Solutions|Global Impact, UTA fosters interdisciplinary research and education within four broad themes: health and the human condition, sustainable urban communities, global environmental impact, and data-driven discovery. UTA was recently cited by U.S. News & World Report as having the second lowest average student debt among U.S. universities. U.S. News & World Report lists UTA as having the fifth highest undergraduate diversity index among national universities. The University is a Hispanic-Serving Institution and is ranked as the top four-year college in Texas for veterans on Military Times' 2017 Best for Vets list.

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