In 2003, in the face of errors and accidents caused by medical and surgical trainees, the American Council of Graduate Medical Education mandated a reduction in resident work hours to eighty per week. Over the course of two and a half years spent observing residents and staff surgeons trying to implement this new regulation, Katherine C. Kellogg discovered that resistance to it was both strong and successful—in fact, two of the three hospitals she studied failed to make the change. Challenging Operations takes up the apparent paradox of medical professionals resisting reforms designed to help them and their patients. Through vivid anecdotes, interviews, and incisive observation and analysis, Kellogg shows the complex ways that institutional reforms spark resistance when they challenge long-standing beliefs, roles, and systems of authority.

At a time when numerous policies have been enacted to address the nation’s soaring medical costs, uneven access to care, and shortage of primary-care physicians, Challenging Operations sheds new light on the difficulty of implementing reforms and offers concrete recommendations for effectively meeting that challenge.

The cost of hospital care has grown so rapidly in the past thirty years that it is threatening to bend our economy completely out of shape. A hospital bed that cost $16 per day in 1950 cost $214 per day by 1978—an increase of more than 1200 per cent! What is the cause of this fantastic inflation, which has been far higher than for any other major good or service? In this pathbreaking book, Martin Feldstein sets forth a novel explanation, provides empirical support for it, and suggests some remedies for the problem.

Feldstein demonstrates a complex relationship between the growing sophistication of hospital care, physician and patient demand, third-party insurance payments, and the tax treatment of insurance premiums. This last, he argues, is the key to the problem in that government policies stimulate the purchase of excessive insurance by a tax deduction and exclusion that cost the Treasury about $10 billion a year. To mitigate the increasingly severe burden of hospital costs, Feldstein recommends that this preferential tax treatment be ended. In its place, he proposes a new national health insurance plan that would give incentives to physicians and their patients to economize on costs and at the same time provide adequate coverage for major illnesses.

In the midst of a crisis of democracy, we have much to learn from Walt Whitman’s journey toward egalitarian selfhood.

Walt Whitman knew a great deal about democracy that we don’t. Most of that knowledge is concentrated in one stunning poem, Song of Myself.

Esteemed cultural and literary thinker Mark Edmundson offers a bold reading of the 1855 poem, included here in its entirety. He finds in the poem the genesis and development of a democratic spirit, for the individual and the nation. Whitman broke from past literature that he saw as “feudal”: obsessed with the noble and great. He wanted instead to celebrate the common and everyday. Song of Myself does this, setting the terms for democratic identity and culture in America. The work captures the drama of becoming an egalitarian individual, as the poet ascends to knowledge and happiness by confronting and overcoming the major obstacles to democratic selfhood. In the course of his journey, the poet addresses God and Jesus, body and soul, the love of kings, the fear of the poor, and the fear of death. The poet’s consciousness enlarges; he can see more, comprehend more, and he has more to teach.

In Edmundson’s account, Whitman’s great poem does not end with its last line. Seven years after the poem was published, Whitman went to work in hospitals, where he attended to the Civil War’s wounded, sick, and dying. He thus became in life the democratic individual he had prophesied in art. Even now, that prophecy gives us words, thoughts, and feelings to feed the democratic spirit of self and nation.