Americans are understandably concerned about the runaway costs of medical care and the fact that one citizen out of seven is without health insurance coverage. Solving these problems is a top priority for the Clinton administration, but as Victor Fuchs shows, the task is enormously complex. In this book Fuchs, America's foremost health economist, provides the reader with the necessary concepts, facts, and analyses to comprehend the complicated issues of health policy. He shows why health care reform that benefits society as a whole will unavoidably burden certain individuals and groups.

Fuchs addresses such central questions as cost containment, managed competition, technology assessment, poverty and health, children's health, and national health insurance. The future of U.S. health policy, he argues, is tightly linked to three basic questions; First, how can we disengage health insurance from employment? Second, how can we tame technological change in health care? And finally how can we cope with the runaway medical costs of an aging society?

Victor Fuchs, author of Who Shall Live?, cuts through the hand wringing and the “pop” panaceas for America's current social crises in a brilliant analysis of the way we live. The facts are familiar. A doubled rate of divorce. A birth rate cut nearly in half while the percentage of illegitimate births nearly tripled. The young face dismal job prospects, and many of the old are totally dependent on the federal government.

Fuchs's economic approach shows us that the societal upheaval of American life is not created by fiat but rather emerges as millions of men and women make seemingly small choices that are constrained by their circumstances: “Should I go back to school?” “How many children should we have?” “When should I retire?” In a masterly synthesis, he shows the interrelatedness of our choices regarding family, work, health, and education throughout the life cycle. He uses the latest facts of American life to explore three major themes—the fading family, the impact of simple demographics on individual destiny, and the effect of weighing present and future costs and benefits on individual choice.

Fuchs concludes by offering innovative solutions to many contemporary problems: social security, health insurance, child care, youth unemployment, and illegitimate births. Moving beyond the outworn orthodoxies of liberalism and conservatism, he offers a clearer view of our circumstances so that readers from all walks of life can make better private choices, and contribute to more effective public policies.

It may seem to the casual observer that women have made striking gains in their quest for equality with men since the early 1960s. But have they really improved their lot? Are they really better off economically? In this clear, compact, and controversial book Victor Fuchs makes plain that except for women who are young, white, unmarried, and well educated, today’s women have not gained economically at all relative to men. He shows that although women are earning a lot more, they have much less leisure time than they used to while men have more; the decline of marriage has made women more dependent on their own income, and their share of financial responsibility for children has grown.

Scrutinizing this relative lack of progress and the reasons for the persistence of occupational segregation, the infamous wage gap, and the unequal responsibility for housework and childcare, Fuchs shows that the standard explanations—discrimination and exploitation by employers—are not the most important causes. Women’s weaker economic position results primarily from conflicts between career and family, conflicts that are stronger for women than for men. Fuchs assembles many different kinds of evidence to suggest that, on average, women feel a stronger desire for children than men do, and have a greater concern for their welfare after they are born. This desire and concern create an economic disadvantage for women, even women who never marry and never have children.