Hospital City, Health Care Nation: Race, Capital, and the Costs of American Health Care (Politics and Culture in Modern America)

"Hospital City, Health Care Nation deftly connects two tragic and persistent crises: that of the modern American city and that of the American health care system. In this timely and important account, we see the profound inequities and inefficiencies of our patchwork public-private health care system unfold at ascending scales, from Baltimore’s neighborhoods to City Hall, to the Maryland statehouse, to the halls of Congress. The consequence, as Guian A. McKee underscores, is not just the notorious combination of steep costs and shallow security in American health care, but the persistent racial inequity of a health system shaped by residential segregation, occupational segregation, market deference, and thin public commitments." ― Colin Gordon, University of Iowa

"In Hospital City, Health Care Nation,Guian A. McKee fuses three stories that have inextricably shaped each other: the inequities of the metropolis, the incursion of the market into ever more sectors of life, and the metastasizing of health care into an ever growing and ever expensive chunk of the American political economy. A must read for scholars, policymakers, and activists wrestling with the health care system’s mounting contradictions." ― Merlin Chowkwanyun, Columbia University

"McKee brilliantly argues that hospitals in the United States have shaped not just health care, but the structure of the postwar city. Hospitals’ increasing access to capital financing and government subsidies led to unchecked growth, which created jobs for city residents but also destroyed housing and sent health care costs soaring. In showing how medical center expansion transformed economies and neighborhoods, Hospital City, Health Care Nation is an essential text for understanding the role of the urban health care sector in creating and maintaining structural inequality." ― Beatrix Hoffman, Northern Illinois University

Hospital City, Health Care Nation recasts the story of the U.S. health care system by emphasizing its economic, social, and medical importance in American communities. Focusing on urban hospitals and academic medical centers, the book argues that the country’s high level of health care spending has allowed such institutions to become vital, if often problematic, economic anchors for communities. Yet that spending has also constrained possibilities for comprehensive health care reform over many decades, even after the passage of the Affordable Care Act in 2010. At the same time, the role of hospitals in urban renewal, in community health provision, and as employers of low-wage workers has contributed directly to racial health disparities.

Guian A. McKee explores these issues through a detailed historical case study of Baltimore’s Johns Hopkins Hospital while also tracing their connections across governmental scales―local, state, and federal. He shows that health care spending and its consequences, rather than insurance coverage alone, are core issues in the decades-long struggle over the American health care system. In particular, Hospital City, Health Care Nation points to the increased role of financial capital after the 1960s in shaping not only hospital growth but also the underlying character of these vital institutions. The book shows how hospitals’ quest for capital has interacted with structural racism and inequality to shape and constrain the U.S. health care system. Building on this reassessment of the hospital system, its politics, and its financing, Hospital City, Health Care Nation offers ideas for the next steps in health care reform.

Guian A. McKee is Associate Professor of Presidential Studies, Miller Center of Public Affairs, University of Virginia, and author of The Problem of Jobs: Liberalism, Race, and Deindustrialization in Philadelphia.