Marcia Angell

Marcia Angell, M.D. is a senior lecturer on social medicine at the Harvard Medical School and former editor-in-chief of The New England Journal of Medicine.

Recent Articles

Health Reform You Shouldn't Believe In

What the Massachusetts experiment teaches us about incremental efforts to increase coverage by expanding private insurance.

For all their promise of change, Democrats are remarkably timid about changing the health-care system. The system now costs twice as much per person as those of other advanced countries and delivers worse average outcomes. It prices tens of millions of people out of health coverage altogether and limits care for countless others. Yet leading Democrats are clinging to this system, proposing to cover more people but not changing the system itself except at the margins. The timidity extends to choice of words. No one is supposed to say "single-payer" or "national health insurance" anymore, because that is "politically unrealistic"; the most we are allowed is to talk of reforming the system incrementally so that someday it will morph into "Medicare for all." Thus, the proposals for reform taken most seriously by Democrats -- including Barack Obama and Hillary Clinton -- would retain the central role of the investor-owned private insurance industry as well as the thousands of for-profit...

Dr. Frist to the Rescue

S en. Bill Frist (R-Tenn., whom The New York Times has taken to calling Dr. Frist), the Senate majority leader and President Bush's new fair-haired boy, wants to fix Medicare. This is the same Bill Frist whose father founded a for-profit hospital chain, Hospital Corporation of America (HCA). Headed by Frist's brother, HCA merged with another hospital chain, Columbia, to form the behemoth Columbia/HCA. After riding high for a few years, Columbia/HCA (now again called HCA) came crashing down when it was charged with massively defrauding Medicare and other insurers. So far it has paid $1.7 billion in fines to settle those charges, and its legal troubles are not over. Not surprisingly, Bush and Frist would fix Medicare by making it more like the fragmented, for-profit insurance system that people under 65 find increasingly unreliable, inadequate and arbitrary. If Democrats engage this issue properly, it should be one of the epic battles of this session of Congress. It's not clear that...

Conversation: Open Science or Junk Science?

On his article on PubMed Central, the NIH's new electronic archive of biomedical research, Harvey Blume paints critics like me as quixotically trying to hold back the Internet (he refers to the controversy as "a tale of new technology versus old, of innovation and inertia"). In fact, my arguments against PubMed Central have nothing to do with the medium and everything to do with the message. I do not think it's a good idea to disseminate bad medical research--on paper, on the Internet, or by any other means--and PubMed Central, as presently envisioned, would make that not only likely, but inevitable. Determining the validity of medical research is no easy matter. To evaluate the papers we receive, The New England Journal of Medicine employs six full-time physician editors, six part-time associate editors in various medical specialties, three statistical consultants, and a consultant in molecular biology, in addition to some 5,000 peer reviewers. We reject over 90 percent of the papers...

Insufficient Credits

As air leaks out of the economic balloon, the number of Americans without health insurance will rise. For two decades, the number--now more than 45 million--has been steadily growing, as it has during all but the last of our eight years of unprecedented prosperity. There are only two large payers for health insurance: government and private employers. Both have large gaps in whom they cover. The federal government, through Medicare, does insure nearly everyone over age 65; but the state-run Medicaid system, along with the four-year-old State Children's Health Insurance Program (SCHIP), covers only a fraction of the poor--children and some parents--using very stringent criteria. Employer-sponsored insurance is spotty in the best of times. Companies may or may not offer it, and workers may or may not accept it. During full employment, employers must compete for workers, so they have an incentive to offer health benefits, at least to skilled employees. In the year 2000, which will...

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