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How capitalism has shaped our perceptions of the natural world, as well as the products of science; some comparison with the Marxist view; special double issue. Partial contents: Science and progress: seven developmental myths in agriculture, by Richard Levins; Biology and social responsibility, by Eric Holtzman; The technological mystique and Third World options, by Maurice Bazin; The radical science movement in the United States, by Jon Beckwith.

Objectives. We estimated taxpayers' current and projected share of US health expenditures, including government payments for public employees' health benefits as well as tax subsidies to private health spending.

Many politicians and business leaders are advocating high deductible health insurance plans linked with health savings accounts—so-called consumer-directed healthcare. These policies penalize the sick, discourage needed care (especially primary and preventive care), and direct tax subsidies towards the wealthiest Americans. They offer little hope of slowing the growth of health care costs and add further bureaucratic costs and complexity to our health care financing system.

Recent developments in health care are strikingly congruent with a Marxist paradigm. For many years small-scale owner/producers (physicians) dominated medicine, & the corporate class supported the expansion of services. As health care has expanded, corporate involvement in the direct provision of services has emerged. This involvement is reflected not only in the rise of for-profit providers, but also in the influence of hospital administration, utilization review organizations, insurance bureaucrats, & other functionaries unfamiliar with the clinical encounter, but well versed on the bottom line. Corporate providers' quest for increasing revenues to bolster profits has brought them into conflict with corporate purchasers of care, whose employee benefit costs have skyrocketed. This intercorporate conflict powerfully shapes health policy. It has caused the rapid proliferation of health maintenance organizations & other forms of prospective payment. Corporate purchasers of care favor the incentives under prospective payment for providers to curtail care & its costs. For corporate providers, prospective payment has allowed increased profits even in the face of constrained revenues, since reimbursement is disconnected from resource use. Unfortunately, this corporate compromise poorly serves patients & physicians. Alternative policy options that challenge corporate interests could simultaneously save money & improve care. AA

The recent explosive growth in health care occurred after the major infectious diseases were already conquered, as a result of changes in public health & the standard of living rather than in curative medicine. The effects of this development on capital accumulation in the medical industry are examined. The emergence of medicine as a field for investment & profit, as distinguished from its roles in enhancing the profitability of other industries & reducing social unrest, is relatively recent. The capitalist class supported the expansion of the medical industry, especially in the hospital sector, through the provision of health care benefits; Medicare & Medicaid also provided funds for expansion. In reponse, proprietary hospitals are rapidly increasing in number. Rising health care costs have evoked reactions from the business community, leading to restrictions on funding & pressures for reorganization. This pressure will radically change the internal structure of the health sector, while still doing little to meet the health needs of the poor. W. H. Stoddard.