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 Almgren
Health Care Politics, Policy, and Services
A Social Justice Analysis, T H I R D E D I T I O N

Health Care
Gunnar Almgren, PhD, MSW

Health Care Politics, Policy, and Services

T his AJN award-winning textbook helps readers understand and critically assess the U.S. health
care system and policies. With a focus on the prevalence of disparities in health and health
care, the book reviews the historical evolution and organization of our health care system. Several

Politics, Policy,
social justice theories are used to critically evaluate current U.S. health care systems and policies,
providing readers with various perspectives of the field. Extensive coverage of our health care
system’s structures, finances, and performance on a variety of population health indicators provides
the necessary background, frameworks, and principles through which the adequacy of alternative
health care system financing strategies can be analyzed.

Highlights include:
• Analyzes the current U.S. health care system and policies from several social justice theories,
providing a critical examination of the field.
• Examines the historical evolvement of the U.S. health care system, its financing and health care
delivery structures, and the prospects for health care reform.
and Services
A Social Justice
• Analyzes disparities in access to health and health care by race, ethnicity, class, age, gender,
and geography.
• Compares the U.S. health care system with that of other democracies, providing a unique
comparative perspective.

New to This Edition:

Analysis
• Revised chapter on health care reform that considers the 2016 election and anticipated
changes to the Affordable Care Act.
• Provides the latest information on the financing and organization of the U.S. health care system. THIRD EDITION
• Examines the nation’s health care needs, the prevalence of health and health care disparities,
and the latest theories that explain the causal origins of health and health care disparities.
• Addresses the latest developments in health care policy domains such as long-term care,
end-of-life care, and initiatives to reduce disparities in health.
• Updated data on long-term financing and expenditures including baby boomers’ increased
demand for long-term services and expanded entitlements for the disabled.

THIRD EDITION
• Updated instructor’s resources include for each chapter: chapter synopsis and learning
objectives, ideas worth grasping, key terms and concepts, discussion questions, and
writing assignments.

This book is an ideal text for graduate courses in health care policy or disparities in the U.S. health
care system in schools of social work, public health, nursing,
medicine, and public policy and administration.
ISBN 978-0-8261-6897-9

11 W. 42nd Street
New York, NY 10036-8002 9 780826 168979 Gunnar Almgren
www.springerpub.com
Health Care Politics, Policy,
and Services
Gunnar Almgren, PhD, MSW, is professor of social work and social welfare at the University
of Washington School of Social Work, Seattle Campus. He joined academia after a 15-year
career as a social work practitioner and administrator in not-for-profit and public health
care systems. His teaching and research interests include health care policy, social welfare
policy, poverty and inequality, research methods, safety-net health care systems, and the
determinants of disparities in health and in health care. In addition to Health Care Politics,
Policy, and Services, he is also the author of Health Care as a Right of Citizenship: The Continu-
ing Evolution of Reform, and coauthor of The Safety-Net Health Care System: Health Care at
the Margins.
Health Care Politics, Policy,
and Services
A SOCIAL JUSTICE ANALYSIS
Third Edition

Gunnar Almgren, PhD, MSW

Copyright © 2018 Springer Publishing Company, LLC

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Title: Health care politics, policy, and services : a social justice analysis / Gunnar Almgren.
Description: Third edition. | New York, NY : Springer Publishing Company, LLC, [2018] |
Includes bibliographical references and index.
Identifiers: LCCN 2017031125 (print) | LCCN 2017031916 (ebook) | ISBN 9780826168986 (ebook) |
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 Contents

Preface  ix
Acknowledgments  xiii
Share Health Care Politics, Policy, and Services: A Social J ustice Analysis,
Third Edition
1. A Primer on Theories of Social Justice and Defining the Problem
of Health Care   1
Defining the Problem of Social Justice   1
Alternative Theories of Social Justice   2
Concluding Comments: Alternative Theoretical Perspectives on
“The Right to Health Care”   26
Notes  34
References  37
2. The Historical Evolvement of the U.S. Health Care System   39
Historical Evolvement of the Basic Components of the Health Care
System: Hospitals, Doctors, Nurses, and Health Insurance  39
The Historical Evolvement of the Federal Government in
Health Care  51
Concluding Comments: Prospects for Achieving Health
Care Reform  77
Notes  77
References  81
3. The Contemporary Organization of Health Care:
Health Care Finance   83
Health Care Expenditures   84
An Overview of Health Care System Finance—Employment-Based
Health Insurance  90
An Overview of Health Care System Finance—Public Financing of
Health Care  107
Concluding Comments: The Large Presence of Public Dollars in the
Financing of Health Care   120
Notes  120
References  122

v
vi Contents

4. The Contemporary Organization of Health Care: Health Care

Services and Utilization   127
The Mixed Public–Private Structure of the U.S. Health
Care System  127
The Resources of the U.S. System: Facilities, Technology, and
Human Resources  129
The Health Care System Safety Net   148
Concluding Comments: The Paradoxical Underachievement of the
U.S. Health Care System   158
Notes  159
References  160

5. Long-Term Care of the Aged and Disabled   165

The Long-Term Care Services System   166
The Sustainability of Resources for Long-Term Care: Caregiving Labor
and Public/Private Financing   181
Directions for Long-Term Financing Policy   187
Concluding Comments: A Social Justice Perspective on the Financing
of Long-Term Care   191
Notes  193
References  194

6. Disparities in Health and Health Care   197

Conceptualizing Disparities in Health and Health Care   197
Measuring Disparities in Health and Health Care   204
Social Characteristics Associated With Disparities in Health and
Health Care  212
Disparities in Health and Burden of Disease:
General Findings 213
Concluding Comments: The Deep Roots of Disparities in
Health Care  224
Notes  225
References  227

7. Social Epidemiology: Unraveling the Social Determinants of

Disparities in Health   231
The Discipline of Social Epidemiology   231
The “Fundamental Social Causes” Hypothesis   239
Income Inequality as a Social Determinant of Health   247
Theoretical Debates Concerning Income Inequality Effects   249
Concluding Comments: Social Epidemiology as a Tool of
Social Policy  259
Notes  260
References  262
 Contents vii

8. Prospects for Just Health Care System Reform: A Political and

Principled Analysis  267
The Social and Political Context of Health Care Reform   267
The Patient Protection and Affordable Care Act (ACA)   281
The Politics of the ACA “Repeal and Replace”: Implications for the
Social Right to Health Care   296
Concluding Comments: Toward a Progressive Vision of Universal
Health Care  301
Notes  304
References  308
Glossary  313
Index  321
 Preface

This widely adopted and award-winning book, now in its third edition, has been
written with the conviction that health care policy courses, which serve as the
policy foundation for students of the health professions, must go well beyond
the traditional descriptive analysis of the health care system, or even other anal-
yses of health care policy that are based on particular disciplinary frameworks.
There continues to be a need for a book that critically examines health care pol-
icy and the structure of the U.S. health care system in light of the prevalence of
disparities in health and health care. This entails looking at how different per-
spectives on social justice might lead to very different conclusions about the cen-
tral purposes and boundaries of health care policy.
Central to the purpose of this book is an ethos that health care practitio-
ners, who have committed their careers and much of their lives to the health of
others, are those who must be at the forefront of the national dialogue on just
health care policy. Health care practitioners are closest to the translation of
health care policy aims and structure into realities of patient care and commu-
nity health needs, and therefore their voices must be the strongest in health care
policy. This book provides health care professionals with the essential prepara-
tion toward that end.
In its opening chapter, the book provides readers with a foundation in alter-
native theories of social justice and their contrasting implications for both health
care rights and the principles that should guide national health care policy. In
the chapters that follow, this analytical perspective is applied to the historical
evolvement of the U.S. health care system; its health care financing and delivery
structures, in both acute and long-term care; and alternative approaches to health
care reform. The book also provides a comparative analysis of the U.S. health
care system that contrasts the organization, expenditures, and outcomes of this
system with those of other modern democracies. Another defining feature of the
book is the extensive analysis it provides of disparities in access to and quality
of health care by race, ethnicity, class, age, gender, and geography and its theo-
retically informed examination of the causal origins of disparities in health that
are rooted in the nation’s economic and social structures.
This newly revised edition of Health Care Politics, Policy, and Services makes
its appearance at a pivotal crossroads in the evolvement of national health care
policy and the nation’s health care system. Over the next few years, as Congress
grapples with the public’s demand that the core policy aims and accomplishments
ix
x Preface

of the Affordable Care Act (ACA) be retained while its shortcomings are addressed
in new health care reform legislation, the defining question will not be whether
the ACA per se survives, but rather whether its central premise and justification
endure—that is, whether the benefits of American citizenship encompass an all-
inclusive social right to an adequate standard of affordable health care. Although
this book does not predict either the future of the ACA or the viability of any
alternative approach to the financing of health care that might plausibly replace
it, the chapters that follow provide the background knowledge, frameworks, and
principles through which the adequacy of alternative health care system financ-
ing strategies can be analyzed.

NEW TO THIS EDITION

The third edition of this book retains the basic structure of preceding editions,
but chapters have been substantially revised with updated content on the financ-
ing and organization of the health care system, the current status of the nation’s
population health and health care needs, the prevalence of health and health care
disparities, and the latest evidence relating to theories that explain the causal
origins of health and health care disparities. The book also addresses the latest
developments in such health care policy domains as long-term care, end-of-life
care, and health care policy initiatives to reduce disparities in health. Particular
attention is devoted to both the accomplishments and deficits of the ACA, a criti-
cal analysis of the legislative approaches advanced by proponents of its repeal
and replacement, and the politics of health care reform that will ultimately
define the future of health care reform.
Also new to this edition is an updated companion Instructor’s Manual, writ-
ten by the book’s author—an award-winning teacher at his university. Included
for each chapter of the main textbook is a chapter synopsis with specific learning
objectives, a list of core ideas worth grasping, key terms and concepts, discus-
sion questions, and writing assignments based on both chapter content and a
theory of developmental writing. Qualified instructors can request the Instruc-
tor’s Manual by e-mail: textbook@springerpub.com.

CONTENTS

The book begins with a primer on alternative theories of social justice and their
implications for the principles of a just health care policy. This first chapter con-
siders the moral foundations of rights to health care in accordance with five
alternative social justice frameworks: libertarianism, utilitarianism, Marxism,
liberalism, and the capabilities approach. The next four chapters then provide
a descriptive and critical analysis of the history of the U.S. health care system,
health care financing, the contemporary organization of health care, and long-
term care policy. With these foundations in place, the next two chapters provide
an analysis of health care disparities and the theoretical frameworks that inform
our understanding of the determinants of disparities in health and health care.
 Preface xi

The final chapter then provides a political and principled analysis of health care
reform, with particular attention to the policy aims and structure of the ACA
and legislation that has been proposed and might plausibly be enacted to replace
it. The book concludes with a health care financing framework that would be in
keeping with both the demands of justice as they pertain to a social right to health
care and the unique social and political context of the U.S. health care system.

INTENDED AUDIENCE

This book is an ideal text for graduate courses in health care policy or disparities
of the U.S. health care system in schools of social work, public health, nursing,
medicine, and public policy and administration. Although the book is written
by a sociologist with a career background in medical social work, it incorporates
theories and substantive findings from an array of social science disciplines,
including medical sociology, social psychology, economics, political science, and
social epidemiology. Nonetheless, students trained in the biological sciences
will find the book to be reader-friendly. Where theories and empirical evidence
from the social sciences are applied to the book’s analysis of particular health care
policy issues, the essential foundational knowledge is concisely summarized.
Although this book is written with careful attention to the facts pertaining
to demographics of the nation’s health and disparities in health care, the chal-
lenges embedded in health care financing and delivery reform, and the social
and political context of health care policy, it is neither neutral nor dispassionate
with respect to the central purposes of health care policy. That is, this book is
written with the conviction that health care policy is first and foremost a com-
plex and multilayered problem of social justice. Whether or not the particular
theory of justice that is favored by the author also resonates with most or even a
small minority of readers, it is hoped that this one central idea is engaging to all.

Gunnar Almgren
 Acknowledgments

I would first like to thank my wife and lifelong partner in all things that matter
in life, Linda Viola Almgren, for her steadfast and generous support throughout
this latest book project. For the content review and updating of various critical
parts of this revised third edition of the book, I am deeply indebted to Elaine M.
Albertson, graduate student research assistant from the University of Washing-
ton School of Public Health. Elaine’s work on the revised manuscript required
incredible tenacity and reflects her very high standards of academic and edito-
rial excellence. I also wish to thank my editorial partners at Springer Publishing
Company: Debra Riegert, Executive Acquisitions Editor, Behavioral Sciences,
and Rose Mary Piscitelli, Senior Editor, Production Department, for their contri-
butions to both the quality of this new edition and their shepherding of the man-
uscript through the production process. Finally, I wish to thank Jitendra Kumar,
Sr. Project Manager, and the editorial staff at Westchester Publishing Services
for their very able work in preparing the book’s final proofs.

xiii
 Share
Health Care Politics, Policy, and Services: A
Social Justice Analysis, Third Edition
ONE

A Primer on Theories of Social Justice and

Defining the Problem of Health Care

The premise of this chapter is that relatively few students in public health, med-
icine, nursing, and social work have more than a superficial acquaintance with
specific theories of social justice. Although this text employs a very specific
(Rawlsian) social justice framework in its analysis of health care policy, the text’s
chosen perspective is contextualized and highlighted by contrasting it with other
dominant theories of social justice. In later chapters, the health care policy impli-
cations of the differing perspectives on social justice are considered.

DEFINING THE PROBLEM OF SOCIAL JUSTICE

The term social justice has many uses and interpretations, but in its most basic
and universal sense, social justice is a philosophical construct—in essence, a
political theory or system of thought used to determine what mutual obligations
flow between the individual and society. As such, social justice is distinct from
the concept of individual justice, the latter pertaining only to obligations that
exist among individuals (Rhodes, Battin, & Silvers, 2002). Also inherent in the
concept of social justice, as it is generally construed within democratic societ-
ies, is the idea that civil society is predicated on the basis of a social contract
that spells out the benefits, rights, and obligations of societal membership.1 For
example, at a very basic level, collective security as a benefit of membership in
civil society is reciprocated through individual obligations pertaining to taxa-
tion and availability for military service.
Beyond these points pertaining to general definition, there is no absolute,
generally agreed-upon notion of what defines or constitutes “social justice,”
either as process or as an outcome. Were that the case, the problem of social
justice would be limited to one of social engineering—ways of organizing social
institutions to ensure that the individuals, groups, and organizations that make
up society act in “just” ways in accordance with the rules of “absolute, true, and
universal” social justice. However, unlike a theocracy comprising culturally
homogeneous and like-minded individuals ascribing to a shared moral and polit-
ical philosophy, a pluralist democracy must accommodate diverse points of
view on what mutual obligations exist, what rules for the governance of mutual
1
2 Health Care Politics, Policy, and Services

obligations should be codified, and how limited resources should be distributed.

Thus, in a pluralist democracy, the problems of social justice are twofold. First,
there is the problem of achieving a conception of social justice that is mutually
recognized and acknowledged by diverse individuals and groups as a legitimate
basis for adjudicating claims on obligations and resources. Second, there is the
problem of how to organize social institutions in accordance with the prevail-
ing conception of social justice (Rawls, 2001).2 This chapter is principally con-
cerned with the first problem, namely, finding a perspective on social justice
that accommodates fundamentally different worldviews, experiences, and
interests.

ALTERNATIVE THEORIES OF SOCIAL JUSTICE

As implied by the general definition of social justice as a philosophical con-

struct, there are very different theoretical perspectives pertaining to the prin-
ciples used to determine what we as individuals are owed as members of society,
and what we in turn owe society at large. A second point of theoretical diversity
concerns the just distribution of limited resources, an aspect of social justice
that is obviously central to health care policy. The social justice perspective that
frames the analysis of health care policy in this chapter, that advanced by John
Rawls, is contrasted with four other different but highly influential theoretical
approaches to social justice: libertarianism, utilitarianism, Marxism, and the
capabilities approach.3 In the review of alternative theories of social justice that
follows, the primary bases of comparison are each theory’s fundamental claims
pertaining to the nature and overall purpose of civil society, which obligations
flow upward from individuals to society, which obligations flow downward
from society to the individual, and the theory’s essential basis for the just dis-
tribution of limited resources.4
It should be noted in the review that follows that the term obligations is
used in a very broad sense to apply to all those acts and actions that either indi-
viduals or social institutions have a responsibility to perform under the prin-
ciples of a given theory of social justice. When we use the term obligations here,
it is meant to apply to acts that might more narrowly be defined as duties rather
than just obligations. A more detailed analysis of alternative theories would
devote more attention to this distinction within each theory. However, for the
limited purposes here, the more general application of the term obligations is
acceptable.5
Broadly speaking, principles of social justice are of three general types: pro-
cedural, redistributive/compensatory, and distributive. Principles pertaining to
procedural justice concern the fairness of the process for determining what is
just, independent of the outcome. Principles pertaining to redistributive/compen-
satory justice are concerned with the determination of punishment and com-
pensation for wrongs, injuries, and losses. Principles that are concerned with
the just allocation of limited benefits and resources pertain to distributive jus-
tice. This book is primarily concerned with this third type of social justice.
 One A Primer on Theories of Social Justice and Defining the Problem of Health Care 3

The Progression of Theories Considered: Emergent Theories of Justice as

“Moral Improvements”
The order of theories reviewed is framed by philosopher William Talbott’s the-
sis that the dominant theories pertaining to human rights and the political
philosophy of just governance represent sequential stages in a progression of
“moral improvements” (Talbott, 2010). Talbott, like Amartya Sen (2009), concedes
that no human society is ever likely to discover the perfect or optimal moral
system. In the absence of a perfect theory of social justice and scheme of human
rights that is universally applicable across all cultural and historical contexts,
we are therefore reliant upon approaches that compare the prevailing moral
philosophies (and the societal arrangements that reflect them) against potential
improvements (Talbott, 2010, pp. 17–18).6
In this vein, the human rights principles of libertarianism thus emerged as
a “moral improvement” over the principles of governance by monarchy, whereas
the consequentialist justification of human rights embedded in utilitarian prin-
ciples emerged in the writings of J. S. Mill in the century following the Ameri-
can Revolution (Mill, 1860). The principles of a Marxist orientation to human
rights and just governance, although they were established by Karl Marx and
Friedrich Engels in their 1848 Communist Manifesto, were not reflected in prin-
ciples of governance until the Bolshevik Revolution in 1917.7 The next theory
of social justice and human rights to emerge was based on the politics of liberal-
ism that were made manifest in the American Progressive Movement and in the
New Deal policies advanced by the Franklin Delano Roosevelt administration—
and then later in the civil rights and social legislation of the Kennedy/Johnson
administrations.8 However, the liberal theory of social justice and human rights
was not formulated as a coherent moral system until John Rawls’s (1971) A Theory
of Justice.
The final dominant theory of social justice to be considered, the capabili-
ties approach, emerged during the 1990s9 in response to what economist and
political philosopher Amartya Sen regarded as significant limitations of Rawls’s
liberal theory of justice. Although Sen had a decades-long collegial relationship
with Rawls and dedicated his most recent treatise on the capabilities approach
(The Idea of Justice, Sen, 2009) to the memory of John Rawls, he questioned the
moral priority that liberalism places on the means of achieving human well-
being (specifically a just scheme of resource allocation) as opposed to the ends
to be achieved, which he defines as the human capabilities that will allow indi-
viduals the freedom to achieve well-being. In addition, Sen rejects Rawls’s lib-
eral theory as being a “transcendental theory of justice,” that is, a theory of
justice that presumes justice can be achieved through the identification of the
nature of “perfect justice” and the institutional arrangements that are presup-
posed to achieve what is either perfect or at least optimal (Sen, 2009, p. 6).10
Instead, Sen advocates for an approach to the advancement of social justice that
is comparative as opposed to abstract. That is, an approach to the conceptualiza-
tion and advancement of social justice that is based on “realization-based” com-
parisons between alternative real-world societal systems of governance, human
rights, and social institutions, as opposed to the epistemological traditions in
4 Health Care Politics, Policy, and Services

Western political philosophy that favor the use of thought experiments that
presuppose the existence of a utopian ideal of a perfect system of justice.11

The Libertarian Theoretical Perspective on Social Justice

The Nature and Overall Purpose of Civil Society
In the classical libertarian perspective, civil society comprises a network of
natural and voluntary associations among autonomous and equal individuals
that in various ways serve human needs (Boaz, 1997). In accordance with this
perspective, societies must be governed, but only to the extent necessary to
ensure the protection of an explicit set of individual rights. As such, government’s
legitimate functions pertain only to basic protections against foreign or domes-
tic threats to life, property, or the exercise of personal autonomy (Nozick, 1974).
For example, governments can legitimately do such things as levy taxes to pro-
vide military and police protection, legislate and enforce laws against theft, fraud,
and breach of contract, and restrain actions by individuals or groups that in other
ways deprive or interfere with the essential civil and property rights of others.
In the dominant libertarian vision of civil society, collective well-being is
best achieved through the exercise of individual free will and self-responsibility
in the context of a laissez-faire market economy. A market economy unre-
strained by burdensome taxes and regulation alleviates poverty and promotes
commonwealth through technological innovation, job creation, and the efficient
production and distribution of goods and services yielded by the free flow of
labor and capital. To the extent there are individual misfortunes12 that result in
poverty (and family resources are absent), mutual aid societies and other chari-
table organizations exist as an outgrowth of voluntary cooperation and factors
such as individual religious conviction. However, because illness, unemploy-
ment, and even old age are risks that are intrinsic to human social existence, it
is the role and responsibility of individuals in a free and civil society to self-
protect through such market mechanisms as (a) insurance and savings, (b) shar-
ing of family resources, and (c) participation in voluntary networks of mutual
aid and protection (e.g., churches, fraternal organizations).13

Which Obligations Flow Upward From Individuals to Society?

Core to libertarian philosophy is the premise that individuals have “full self-
ownership,” meaning that individuals have a moral right to grant or deny use of
any aspect of their person on whatever basis they determine aligns with their
preference, individual moral philosophy, or self-interest. It also means that indi-
viduals have full immunity or protection against the “nonconsensual” loss of their
rights to self-ownership—except where the individual violates the rights of others
(Vallentyne & van der Vossen, 2014). A second core premise of libertarian
social philosophy is that individuals also have the moral right to acquire prop-
erty rights in external things (objects outside the person) that, if acquired legit-
imately, are also immune from nonconsensual loss.14 A third and related core
premise of libertarianism concerns the use of coercion by governments, institutions,
or individuals. In accordance with this third core premise, it is not permissible
 One A Primer on Theories of Social Justice and Defining the Problem of Health Care 5

to employ coercion or the use of force to either (a) benefit the person, (b) benefit
others, or (c) prevent third parties from violating the rights of others (Vallen-
tyne & van der Vossen, 2014, p. 1). A fourth core premise, mentioned previ-
ously, concerns the minimalist role of governments, in essence, the position
that governmental functions should be limited to the protection of life, prop-
erty, and the exercise of personal autonomy (Nozick, 1974). Collectively, these
premises imply that the obligations that flow from individuals to society are
limited to those that involve overt or explicit consent, and, in the case of individ-
ual obligations to the government, are limited to those essential for the preser-
vation of collective security and individual liberty, such as taxation for national
defense and law enforcement. Indeed, other than those obligations assumed
under explicit and free consent, the only other obligations owed by individuals
to society at large are those that involve a duty not to violate the essential rights
of others (Vallentyne & van der Vossen, 2014).15
Notably, libertarians do not dismiss the idea that individuals have moral
responsibilities, or that various obligations do not arise from their status as
moral actors. In the libertarian thought, it is entirely compatible for a libertar-
ian to voluntarily hold himself or herself to a stringent moral philosophy that
requires that in every action he or she places the well-being of others before
his or her own narrow self-interest. It is also the case that libertarians place
great emphasis on the notion that the free agency carries with it the full bur-
den of accountability for whatever good or evil might result from one’s actions
(Clarke, 2003).
The dignity that one has in virtue of being a free agent, then, consists in
one’s making a difference, by one’s exercise of active control, in how things go
in the world. It consists of one’s actions (and some of their consequences) being
attributable to the individual self as source and author, and, provided that one
has an ordinary capacity to appreciate and act for moral reasons, in one’s being
responsible for one’s actions (and some of their consequences).16
Although we can clearly read the foregoing account of libertarian free will
as a heavy imperative that individuals should strive to do good in the world and
should pursue existence as atomistic and egocentric beings, the distinct thread
of libertarianism is retained through the exercise of free will in selecting one’s
individual moral philosophy. The central point of libertarianism concerning the
obligations that flow from the individual to the society at large is that obliga-
tions toward others in society are a matter of free choice, other than the non-
consensual obligation or duty to not violate the libertarian rights of others
(Vallentyne & van der Vossen, 2014).

Which Obligations Flow Downward From Society to the Individual?

As implied by the preceding summary of the libertarian perspective on the flow
of obligations from the individual to society as a whole, as well as the libertar-
ian perspective on the nature of society, the obligations that flow downward from
the society to the individuals would seem to be quite limited. If, as libertarians
argue, civil societies are spontaneous entities composed of a network of natural
and voluntary associations (Boaz, 1997), then it is difficult to find any basis for
6 Health Care Politics, Policy, and Services

assuming which (if any) obligations toward individuals actually encumber

society at large. However, in the classic libertarian framework, there are two
kinds of obligations that flow from society to the individuals: those that pertain
to the preservation of a limited set of natural rights and those that arise from
voluntary social contracts between individuals and the organizations, institu-
tions, and communities they choose to join.
In the utopian society described by classic libertarian theorist Robert Nozick
(1974), individuals are free to form, enter, and exit any of a multitude of diverse
communities, each expressing a different vision of what values should govern
individual lives and what values should govern communal relationships. As
stated by Nozick (1974, p. 312), there is no utopian society writ large with a sin-
gle encompassing vision of ideal social existence, but rather a society com-
prised of a collection of many different kinds of communities that accommodate
diverse individual preferences. In this vision of society, individuals are at lib-
erty to choose which community to join or leave; membership in any one com-
munity can entail a large set of restrictions on individual freedom and extensive
mutual obligations between the individual and the community at large. Accord-
ingly, an individual may choose to join a highly socialistic community, or, at the
other extreme, may choose to join a highly laissez-faire community having min-
imal constraints on individual behavior and very few mutual obligations.17
Thus, libertarian theory really does not oppose the idea that an extensive set of
entitlements and obligations can flow downward from society to the individual
(or vice versa), per se, just as long as those more extensive entitlements and
obligations are a function of a social contract enacted by voluntary membership
in a community composed of other like-minded individuals.18
In contrast to this benign view of the entitlements and obligations that might
arise in voluntary communities, libertarians consider entitlements and obliga-
tions that flow through any kind of central government to be inherently sus-
pect, if not pernicious. The philosophical basis for this libertarian aversion to
central government is typically attributed to John Locke’s Second Treatise of
Government written in 1690, wherein Locke argues that (a) individuals possess
an essential set of natural rights that precede the formation of governments,
(b) governments are formed to protect natural rights, and (c) governments that
exceed their protectionist role and impinge on individual rights lose their basis
of legitimacy (Boaz, 1997; Nozick, 1974). Although there are strains of libertari-
anism that are willing to extend the protectionist role to equality of opportunity
(Otsuka, 1998; Vallentyne & van der Vossen, 2014), advocates of classic liber-
tarianism emphasize the idea of the “minimal state” described previously—one
that is limited to “the functions of protecting its citizens against violence,
theft, and fraud, and to the enforcement of contracts” (Nozick, 1974, p. 26).
Libertarian theory is popular among individuals who, for various reasons
(and often good ones), believe that governments do things badly. However, in
the classic libertarian framework, the reasons why governments are inefficient
(and even pernicious) are tied to issues of human diversity and political plural-
ism. According to this line of reasoning, if it is presumed that individuals have
a natural right to live life as they choose (as long as their actions are not harm-
ful to the natural rights of others), and that society is composed of individuals
 One A Primer on Theories of Social Justice and Defining the Problem of Health Care 7

having diverse preferences and beliefs about what constitutes personal security
and the requisites of happiness, then how is it possible to sustain a form of gov-
ernment that serves all individual ideologies and preferences? The answer is
that central governments in fact cannot, and that by some method (be it demo-
cratic or authoritarian), central governments are bound to select and impose
duties, mutual obligations, and limits to freedom that force some individuals to
conform to the social ideologies of others. The objection to the central gov-
ernment being the purveyor of mutual social obligations, as opposed to com-
munities and other voluntary forms of human association, is that individuals
cannot “opt out” and seek other alternatives short of renouncing citizenship and
fleeing—which itself defeats the very purpose of having a central government.

The Utilitarian Theoretical Perspective on Social Justice

The Nature and Overall Purpose of Civil Society
Classic utilitarians, like libertarians, assume that society is founded upon, and
to a large extent justified by, voluntary relationships formed for purposes of
mutual advantage (Barry, 1989; Roemer, 1996). It can be said that the origin of
the utilitarian perspective on social justice begins with Aristotle’s notion of dis-
tributive justice, which in essence views the just distribution of the goods and
benefits of society as a legitimate function of the state (Miller, 2017). That being
said, Aristotle himself was not in any sense a utilitarian, because his criteria for
the just distribution of goods and benefits rest on the merits of the individual
rather than upon the principle of utility—the latter being the hallmark of classic
utilitarianism introduced in its full form by John Stewart Mill in his (1863)
essay titled Utilitarianism.19 In simple form, this principle states that utility
(whatever is valued as a good thing) should be distributed in accordance with
whichever scheme yields the maximum good to the maximum number of people
(Rescher, 1966). The principle of utility, taken at face value, suggests that civil
society should be organized in highly rationalistic terms (some would say even
in calculated terms) to achieve the maximum social good for the most number
of persons. Accordingly, the primary problem of distributive justice becomes one
of economics, or, in the words of eminent economist John Roemer, that system of
resource allocation, “which maximizes the sum total of utility over persons”
(Roemer, 1996, p. 5).
Taken to this extreme, the doctrinaire utilitarian society would be relatively
unconcerned with problems of either extremes of deprivation or extremes of
abundance, as long as the maximum good to the maximum number outcome is
served. Although one might question the political viability or moral basis of such
a system of social organization and governance, in effect this utilitarian doc-
trine has been underscored and emphasized as a rationale for a number of eco-
nomic and social policies that clearly benefit some groups over others, such as
tax policies that by many accounts contribute to rising concentrations of wealth
via such arguments as “a rising tide lifts all boats” (Pizzigati, 2005). The remark-
able level of acceptance among Americans for this line of argument suggests
that utilitarianism in fact has broad intuitive appeal as a significant foundation
for social policy on a variety of fronts, including health care.
8 Health Care Politics, Policy, and Services

Which Obligations Flow Upward From Individuals to Society?

To get to an idea of which obligations flow upward from individuals to society
(and vice versa), three concepts are key. First is consequentialist theory, in
essence, theories that hold that individual obligations are a function of their out-
comes. The second key concept is the ethical principle of rule utilitarianism,
meaning in essence that the rightness or wrongness of acts is evaluated in accor-
dance with a set of rules that themselves have (over time) managed to achieve
the maximization of the common good. Third is the now familiar idea of the
social contract, described earlier as the idea that civil society is predicated on
the basis of a social contract that spells out the benefits, rights, and obligations
of societal membership. Thus, in accordance with the utilitarian premise that
the ultimate function of society is the promotion of the maximum level of com-
mon good, the primary basis for determining the social rules (e.g., laws, social
policies, civic duties) is whether or not they are genuinely intended for the com-
mon good—even if one’s own happiness and well-being (or utility) are compro-
mised. Conversely, this also implies that utilitarian ethics do not obligate one
to act in accordance with rules that do not serve the maximization of the com-
mon good.
As an example, consider a tax that is levied for road construction, under the
premise that there is a consensus among voters that building a particular arte-
rial is essential to commerce and public safety. Even though a utilitarian citizen
may not drive or even personally agree that the proposed arterial is needed, he
or she is obligated to pay his or her share of the taxes because the decision to
build the road was determined (a) by the rules of democratic process (presum-
ably adopted because they maximize the common good) and (b) the utilitarian
justification that the proposed road itself serves to maximize the common good.
However, suppose that it is shown that the proposed road is actually an overly
priced boondoggle, put before the voters to benefit a select contractor with a lot
of political influence. Would our citizen utilitarian still have the ethical obliga-
tion to pay the taxes levied for the boondoggle arterial? If the voting process
itself were not corrupt, the answer would seem to be yes—the premise being
that accountability to the outcome of the democratic process remains justified
under the ethical principle of rule utilitarianism. If, on the other hand, both the
democratic process was not adhered to and the road project was not in ser-
vice of the common good, then our utilitarian citizen will not in any sense vio-
late his or her ethical principles by refusing to pay taxes for the road because
there is no aspect of social contract that was not violated (however, he or she still
might be thrown in jail).
The only other general obligations that flow upward from individuals to soci-
ety are those that concern restraint from doing evil or harm, or negative utili-
tarianism. Simply stated, there is a utilitarian principle that also states that the
rightness of actions should also be evaluated by producing the least harm to the
least number of people, or performing actions that prevent the most harm to
the most number of people. Accordingly, a social contract that is consistent with
utilitarianism can also include obligations that are aimed at either constraining
harmful behavior or even obligating the individual to perform duties that are
 One A Primer on Theories of Social Justice and Defining the Problem of Health Care 9

aimed at preventing harm. As an example, it is legitimate from a utilitarian per-

spective that a village obligates every person who is physically capable to help
pile sandbags along a river that is on the verge of flooding. From a health care
policy perspective, negative utilitarianism underscores the justification of rules
governing personal health behavior—including sexual conduct, management
of personal illness, and tobacco use.

Which Obligations Flow Downward From Society to the Individual?

Utilitarianism does not prescribe a specific set of societal obligations toward
individuals, but rather provides general ethical criteria for the evaluation of the
laws and other social policies that distribute the benefits and resources of soci-
ety. In this sense, though, utilitarian theory is an extremely potent determinant
of societal obligations. Consistent with the ethical obligations of individuals,
utilitarian principles hold that social arrangements and actions should (a) max-
imize the sum of happiness and well-being over the most number of persons,
(b) do the least harm to the least number of persons, or (c) prevent the most harm
to the most number of persons. By strict utilitarian standards, this suggests
that governments are not ethically obligated to respect any aspect of individual
autonomy, happiness, or well-being that runs counter to the maximization of the
general good of all—per the ruthless utopia depicted in Aldous Huxley’s (origi-
nally published in 1932) Brave New World (Huxley, 1998).
However, most utilitarian thinkers promote a strain of utilitarianism that
recognizes that there are some limits to the utilitarian principle where the
­so-called natural rights of individuals are at stake, such as life and liberty. For
example, few utilitarian ethicists condone violent actions of governments or
individuals that take the lives of innocents in order to prevent the deaths of many
others, or suggest a rigid application of a strict cost–benefit analysis to the pro-
vision of all forms of health care. Rather, most utilitarian thinkers temper their
utilitarianism with other fundamental considerations of justice that are not
themselves derived from utilitarian theory, such as recognition of a minimum
subsistence threshold for the distribution of essential goods. Along this line,
distributive justice philosopher Nicolas Rescher (1966) proposed a “qualified
utilitarianism” that adds all other things being equal to the basic “greatest good
to the greatest number” principle of utility—these other things referring to other
relevant principles of justice (Rescher, 1966, pp. 115–117).

A Marxist Theoretical Perspective on Social Justice

There is no single Marxist theory of social justice per se, but rather a variety of
interpretations of how the extensive political and historical works of Karl Marx
and Friedrich Engels (spanning the 19th century from 1841 to 1895) lead to an
implicit theory of social justice. The Marxist theory of social justice that is
selected for this chapter is explicated in Rodney Peffer’s (1990) Marxism, Moral-
ity, and Social Justice, which many would agree is a rigorous and exhaustive treat-
ment of this subject.20 However, it should be noted and emphasized that any
scholarly interpretations of Marxist thought are generally (and often hotly)
10 Health Care Politics, Policy, and Services

contested among Marxists and non-Marxists alike. As such, Peffer’s Marxist the-
ory of social justice stands as an exemplar of a Marxist social justice framework
rather than the definitive Marxist theory of social justice.

The Nature and Overall Purpose of Civil Society

The central tenet of Marxist theory is historical materialism, which stated in the
simplest terms claims that the particular social arrangements that comprise dif-
ferent forms of society (social systems) are determined by the modes of produc-
tion that are dominant in any given historical epoch. Over time, less efficient
social systems (those that fail to maximize the dominant mode of production)
give way to social systems that are more efficient with respect to the maximiza-
tion of production (Peffer, 1990). The image of society that became the basis for
Marxist theory was 19th-century England; a social system with a rigid class
structure and ruthless class oppression that was greatly transformed by the
Industrial Revolution that had taken place over the preceding 100 years. Thus,
class exploitation and conflict lie at the heart of the Marxist perspective of the
nature of society and constitute a central theme of contemporary Marxist writ-
ings pertaining to issues of social justice.
Although it can be said that the Marxist21 perspective on the nature of society
rests upon an explicit theory of economic determinism and class conflict, the
classic Marxist perspective on the overall purpose of civil society can be gleaned
only indirectly—since neither Marx nor Engels can be said to have produced a
unified moral theory.22 However, one can gain a foothold on the Marxist concep-
tion of the purpose of society by examining (a) the central themes of Marx’s
critiques of 19th-century social systems, (b) the fundamental merits of the com-
munist social system Marx viewed as morally superior to capitalism, and (c) the
Marxist criteria for a morally justified revolution—as argued by Peffer (1990).
Concerning the first point, insomuch as Marx viewed the capitalist social sys-
tems as pernicious and exploitive because a large segment of society suffers pov-
erty and fails to find personal fulfillment or freedom and self-determination, it
can be assumed that Marx regarded such things as legitimate claims or expecta-
tions of everyday citizens. Regarding the second point (the relative virtue of the
communist social system over others), Marx’s famous dictum that such a sys-
tem would ensure that “each contributes according to their ability and receives
according to their need” strongly suggests themes of equity and commonwealth
as core purposes of society (Wolff, 2017). Finally, as Peffer’s interpretation of
Marxist theory of social justice would have it, people have a legitimate basis for
rebellion where governments (a) fail to secure basic rights of well-being, (b) fail
to secure “maximum equal liberty” among citizens, (c) fail to provide equality of
opportunity, or (d) fail to eliminate unjust social and economic inequalities.23
Marxist thinkers differ greatly on the extent to which the social systems
they endorse or believe will incorporate all aspects of doctrinaire Marxism. Pef-
fer’s approach to a Marxist theory of social justice rests upon the model of a
“democratic, self-managing socialist” society, which he argues is the social sys-
tem that is most able (in the current historical epoch) to fulfill the Marxist
principles of social justice he puts forth. In such a society, the core tenets of
Another random document with
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 Ath p180 F 6 ’20 1250w

“Taken as a whole, Mr Muscio’s volume may be recommended

particularly on account of its lucidity and common sense as
providing what is probably the best short account yet published in
this field. In certain places, however, these lectures are distinctly
weak. The author sometimes betrays only a distant acquaintance
with the statistical material of his subject. Another weakness of these
lectures is their too great reliance on the anecdotal method.” P. S.
Florence

+ − Freeman 2:117 O 13 ’20 600w

R of Rs 62:447 O ’20 30w

“There is no other book for the general reader that states the case
for a scientific handling of the human factor in industry more clearly
or more convincingly.” B. L.

+ Survey 44:638 Ag 16 ’20 280w

MUZZEY, DAVID SAVILLE. American history.

il *$1.92 Ginn 973

20–10077

A prefatory note to this revised edition says, “Besides bringing the

narrative down to the spring months of the year 1920, the author has
entirely recast that part of the book following the Spanish war, and
has made considerable changes in the preceding chapters. The
changes are chiefly in the direction of added emphasis on social and
economic factors in our history. New illustrative material has been
added, the maps have been improved, and the bibliographical
references brought down to date.” The work was first published in
1911.

+ School R 28:548 S ’20 340w

MYERS, ANNA BALMER. Patchwork; a story of

the “plain people.” il *$1.75 (2c) Jacobs

20–5190

The “plain people” is what the religious sects, Mennonites, Amish,

etc., in the Pennsylvania Dutch country are called. Phœbe Metz was a
child of the “plain people” and this is her story from the time she was
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until she told David Eby that she would be his wife. She was fond of
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how much they had cared since they were children. There is much
charm in the book’s local coloring.
 “Entertaining but with less convincing dialect and background
than Mrs Martin’s ‘Tillie.’”

+ − Booklist 16:349 Jl ’20

“There is a good deal of information about the ‘plain sects,’ their

ways and speech and ideas, in this perfectly innocuous little story.”

+ − N Y Times 25:321 Je 20 ’20 320w

MYERS, FREDERIC WILLIAM HENRY.

Human personality and its survival of bodily death.
*$4 Longmans 133.9

“This well-known work first appeared about sixteen years ago in

two volumes, each of about seven hundred pages in length. The text
is here materially condensed, and most of the appendices, which
occupied about half each volume and contained examples of
phenomena analysed in the text, are omitted. A short biographical
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“As Myers’ theory develops to include more and more unusual

phenomena it preserves its persuasiveness and elasticity: Myers’
patient skill is indeed the most attractive feature of the book.” J. W.
N. S.

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Reviewed by Joseph Jastrow

 Dial 69:201 Ag ’20 1150w
+ Outlook 125:281 Je 9 ’20 140w
+ Springf’d Republican p11a Je 20 ’20
650w
The Times [London] Lit Sup p719 D 4
’19 60w

[2]
MYERSON, ABRAHAM. Nervous housewife.
*$2.25 (4½c) Little 616.8

20–21011

“Every practicing physician, every hospital clinic, finds her a

problem, evoking pity, concern, exasperation, and despair.” (Introd.
note) By examining the various causes and forms of nervousness in
housewives, from merely deënergizing neurasthenia to highly
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to promote a more constructive and intelligent rebellion against old-
established conditions and discontents. The book is indexed and the
chapter headings are: The nature of “nervousness”; Types of
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husband; Histories of some severe cases; Other typical cases;
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and marriage.
 “Written sympathetically and sensibly for the housewife herself to
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“There is a note of pessimism about the book, despite its

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on the whole the book is sane, frank without being indelicate, wise,
and fairly well-written.”

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 N

NALKOWSKA, SOFJA RYGIER. Kobiety

(women). il *$2 (3c) Putnam

21–492

This novel of Polish life has been translated from the Polish by
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passion, coquettes with it, longs for it and, when it comes rejects it—
from an inherited instinct of chastity. In the words of a rejected
lover, she was: “A bundle of theories, of sentimental scepticism, of
self-assurance.... A poor frightened bird always popping its head
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grieved when she had disappointed his hopes for her and had turned
her back upon science. The confessions are in three parts: Ice-plains;
“The garden of red flowers”; A canticle of love.

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the mediocre, superficial writing through which a reviewer, in the
course of his duty, must wade is like emerging from the subway and
drawing pure air into the lungs. The translator has done excellent
work and the Benda drawing is distinctive.”
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Reviewed by H. W. Boynton

Review 3:451 N 10 ’20 720w

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NAPIER, MARGARET. Songs of the dead.

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product; that they are a rough diamond from a matrix suggesting
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in realized execution. Miss Napier writes in free verse, in a curiously
tortured style full of inversions (one has the feeling that she is trying
to express, by the unnatural quality of the style, the more than
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NATHAN, GEORGE JEAN, and MENCKEN,

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knowledge of music.”

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themselves do not know American character, even in its major
aspects, but only its ludicrous or despicable blemishes.”

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NATHAN, ROBERT. Peter Kindred. *$2 (2c)

Duffield

20–1889

The story of a boy’s school and college life, and his first contacts
with the outer world. Peter’s father sends him to Phillips Exeter with
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character. He makes friends, is converted to Carverism—the
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story ends with the birth and death of their child.

“Unluckily there is not quite enough ‘to him’ to command and hold
our interest and concern at the exacted pitch.” H. W. Boynton

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through the first two hundred pages of ‘Peter Kindred’ will find in the
last part of the book a realistic sketch of youthful theories and ideals
at war with the economic facts of life.”

− + N Y Times 25:50 Ja 25 ’20 300w

“The story is well thought out and well written. Mr Nathan has put
a great deal into his work and has taken it seriously. That in itself is
more than can be said for many writers of current fiction.”

+ Outlook 124:479 Mr 17 ’20 240w

“The boy is a tolerably nice boy, and he does and thinks and says
the things a tolerably nice boy would. We do not deny that he is true
to fact. But what of it? Who cares? Since the author has failed to
make us care about him as a person?” H. W. Boynton

+ − Review 2:392 Ap 17 ’20 900w

NEALE, REGINALD EDGAR. Electricity. il $1

Pitman 621.3

20–16269

“In this book the author attempts no more than a review of the
general nature of electricity, the methods of producing it and the
services to which it is applied.” (Preface) The book is illustrated with
forty-five figures in the text. It is issued as one of Pitman’s common
commodities and industries series.
 “It is remarkable how complete and accurate is the information
given. The reader is, however, hurried on unpleasantly fast, and is
never allowed to pause where his interest is aroused.”

+ − Nature 105:804 Ag 26 ’20 230w

[2]
NEIHARDT, JOHN GNEISENAU. Splendid
wayfaring. il *$2.25 Macmillan 978

20–27591

“As a poet, picturing the savage adventure of the early days of the
Yankee invasion of the plains and mountains, Mr Neihardt has
already won his reputation: his theme is huge and his powers are not
unworthy of it. In his new volume, a prose volume, he appears again
in his chosen domain, now as an historian. The period taken is 1822
to 1831, the event is the career of Jedediah Smith, who in the eight
years of his adventurous maturity was the first American leader to
discover the central overland route to California—later the great
immigrant and trade route—and to measure the length of the Pacific
coast from Los Angeles to the Columbia.”—Bookm

“Mr Neihardt gives unity and verve to his volume by making Smith
the central spirit: but it is in a truly epic mode that the story is
conceived, and hence there could not be less than a picturesque
emphasis upon the companions of the hero, among them Ashley and
Henry, builders of the fur industry, and the trapper Hugh Glass who
is the subject of one of Mr Neihardt’s best-known poems.” Hartley
Alexander
 + Bookm 52:360 Ja ’21 580w

“All this is fascinating reading, suggesting the lurid tales, much

sought and pored over, in boyhood, but while it is fascinating, it is
history, history of the growth of the United States; as important as
the occupation of the older states and the taking of the central
portion of the present union.” J. S. B.

+ Boston Transcript p2 N 24 ’20 570w

“This task has evidently been a labour of love, for Mr Neihardt has
not felt impelled to follow the pattern of angular, unimaginative
recital into which so many books of this kind fall.” L. B.

+ Freeman 2:478 Ja 26 ’21 180w

“A parallel work by, say McMaster, and called, say ‘Western

exploration from 1822–1831,’ would have been a valuable
contribution to the history of the West; but ‘The splendid wayfaring,’
as the title plainly shows, is more than that; it is an American prose
epic, an absorbing tale of courage and endurance.” Walter Franzen

+ N Y Evening Post p14 D 4 ’20 520w

“Mr Neihardt has for the subject of this prose story one of the truly
dramatic themes of American history.”

+ R of Rs 63:223 F ’21 110w

 “Mr Neihardt has allowed himself a rather lofty flight in his
opening paragraphs, where he links his tale up with that of the
western progress of the Aryan races. In a number of other places a
tendency to ornate language may be observed. But in other respects
‘The splendid wayfaring’ has compelling force.”

+ Springf’d Republican p10 D 17 ’20 300w

“Mr Neihardt has succeeded in giving some epical quality to his

heroes and painting, as he intended to do, the mood of their
adventures.” M. C. C.

+ − Survey 45:578 Ja 15 ’21 240w

[2]
NEKLIUDOV, ANATOLII VASIL’EVICH.
Diplomatic reminiscences before and during the
world war, 1911–1917; tr. from the French, by
Alexandra Paget. *$8 Dutton

(Eng ed 20–10794)

“A Russian diplomat’s frank statement of what he learned as

Minister to Bulgaria during the Balkan wars of 1912 and of 1913,
supplemented by his observations during the world war, when he
was serving as Minister to Sweden, and Ambassador to Spain.
Writing in the firm conviction that all who took part in the
tremendous events of those years now belong to ‘an irrevocable past,’
M. Nekliudov speaks as freely concerning his contemporaries as if
they were actually dead.”—R of Rs
 “M. Nekliudov, with his tears and his discontents, is not a very
interesting person. The best part of his long book is the record of his
ambassadorship in Sweden during the war, and in his comments on
certain Russian statesmen such as Stürmer and Protopopoff he has
something to say that is not without interest.”

− + Ath p205 Ag 13 ’20 270w

R of Rs 63:109 Ja ’21 90w

“The style is more than clear and studiously temperate: it is at

times eloquent and pathetic, and throughout tinged with the
philosophy natural to a cultured gentleman. The English of
Alexandra Paget is so good that it must, we think, be ranked as a
first-rate translation.”

+ Sat R 130:94 Jl 31 ’20 1000w

+ Spec 124:87 Jl 17 ’20 210w

“Having lost his emperor, his country and his sons, this former
representative of a departed system sees no necessity to guard
certain of those secrets which go to make up the mystery of
diplomacy. In consequence of this break with the past which fate has
forced upon him M. Nekliudov is interesting and informative.”

+ The Times [London] Lit Sup p343 Je 3

’20 1300w

NEW Decameron; second day. *$1.90 McBride

 20–8740

The first volume was published last year. Like it this second
volume is a collection of short stories by different authors, each story
in keeping with the character of its narrator. Contents: Jim of
Moloch’s bar, by Francis Carco: Bread upon the waters, by Michael
Sadleir; The history of Andrew Niggs, by Basil Blackwell; The tool, by
W. F. Harvey; The master-thief, by Dorothy L. Sayers; The affair of
the Mulhaven baby, by M. Nightingale; The vase, by Camilla Doyle;
“Once upon a time” by Bill Nobbs; A prayer perforce, by M. Storm
Jameson; Salvator Street, by Sherard Vines.

“In spite of serious inequalities in the work, the total result is

undoubtedly entertaining. In all the stories there is evidence of
careful workmanship, a preoccupation with literary means which is
highly satisfactory save when it aims at effect with too unchastened
self-consciousness.” F. W. S.

+ Ath p172 Ag 6 ’20 520w

“Some of them are excellent, some rather poor and a few

unequivocally dull. Heralded simply as ‘Salvator street’ comes the
surprise of the book. In it Sherard Vines has succeeded in creating a
character besides writing the best story of the volume.”

+ Boston Transcript p4 D 11 ’20 350w

“The idea of vocational guidance in the telling of tales is not

altogether conducive to the best flights of the imagination. The
obligation to relate the sort of story that a master-printer, a poet, or a
psychic researcher would be apt to relate seems to have put a
restraint upon most of the contributors.” L. B.
 − Freeman 2:501 F 2 ’21 130w

“‘The new Decameron,’ to carry on its excellent plan, must be, like
the ‘Canterbury tales’ which its general method recalls, more
variously human in substance and in modulation. Their
inventiveness in plot and ingenuity in structure are remarkable. But
these are not high qualities in fiction. ‘The new Decameron’ needs
not, indeed, cheerfulness, but sunlight; less smell of the charnel
house and more of the earth.”

− + Nation 111:596 N 24 ’20 260w

“The structure of the book is cleverly contrived, and in reading it

the fact that this is the work of several hands does not obtrude itself
too violently. At its best the book is artistic, and it is always elegant.
The remoteness, the wickedness, and the nervous dread of crudity
dissociate the authors from the literary giants of past times. All the
contributors give an impression of literary taste, and not one of them
has generated a ‘human document.’”

+ − The Times [London] Lit Sup p363 Je 10

’20 550w

[2]
NEWBOLT, SIR HENRY JOHN. Book of
good hunting. il *$3.50 (*10s 6d) Longmans 799

20–18594

“Sir Henry Newbolt has put together many interesting stories

about sport. Elephants, lions, and tigers come first: then there are
chapters on deer-hunting and fox-hunting, with many extracts from
Mr Masefield’s fine poem, ‘Reynard the fox,’ and a closing chapter on
fishing. In his introductory chapter, ‘On the nature of sport,’ he
states the arguments for and against sport, and insists very strongly
on the value of true sportsmanship to the national character.”—Spec

+ Ath p649 N 12 ’20 500w

“Sir Henry Newbolt writes so pleasantly that he will attract readers

of all ages.”

+ Spec 125:710 N 27 ’20 90w

“From a literary or sporting standpoint, the book is equally

attractive.”

+ Springf’d Republican p10 Ja 18 ’21 320w

“The instances of hunting experiences chosen by Sir Henry are

admirably described, and compel the reader to share the excitement
of the hunter. He brings out all the concomitants which differentiate
sport from killing.”

+ The Times [London] Lit Sup p825 D 9

’20 950w
 NEWLAND, H. OSMAN. Romance of modern
commerce. il *$2 Lippincott 380

20–3902

“The book is, as described in its sub-title, a popular account of the

production of a number of common commodities. It collects a mass
of miscellaneous information about wheat and other cereals, tea,
coffee and cocoa, rubber, tobacco, cotton, silk, wool, timber, paper,
fruit and wine, cattle and leather, vegetable and mineral oils, furs
and feathers, precious stones and metals.”—The Times [London] Lit
Sup

“Informative and of varying interest. Could be used by upper

grades and high schools.”

+ Booklist 17:55 N ’20

Brooklyn 12:126 My ’20 20w
R of Rs 62:448 O ’20 30w
+ − The Times [London] Lit Sup p748 D 11
’19 150w

NEWMAN, ERNEST. Musical motley. *$1.50

Lane 780.4

20–1630
 A series of papers by an English musical critic. Among the titles
are: “L’enfant prodigue”; On instruments and their players; On
musical surgery; Criticism by code; Futurist music; The best hundred
scores.

“Mr Newman is a musician of the nineteenth century. This must

not be taken to mean that he is an old-fashioned pedant who is out of
touch with new developments. On the contrary, he is intensely
interested in modern music and has no sentimental illusions about
that of the past. Music is for him always a thing of the living present.”
E: J. Dent

+ Ath p1010 O 10 ’19 900w

+ Booklist 16:232 Ap ’20

“Mr Newman is never dull, even when he is grave.” H: T. Finck

+ Bookm 51:169 Ap ’20 440w

“The chief attraction of Mr Newman’s book, besides its dry humor,

is its lack of dogmatism and its corresponding illumination of
speculative points.” M. H.

+ New Repub 22:168 Mr 31 ’20 520w

+ R of Rs 61:224 F ’20 80w

“He differs from a good many fashionable critics in his familiarity

with the works of the ancients, and in testing the moderns by
standards which these critics are either ignorant of, or refuse to
accept. Perhaps the wisest and sanest passages in the book are those