Chapter 1.B.1--Overview of Medicine and the Health Care Delivery System

This helpful diagram captures many of the competing themes and attitudes mentioned in this chapter (from David W. Johnson & Nancy M. Kane, The Healthcare System: A Produce of American History and Values (2008), reprinted with permission).

Revisiting and updating Paul Starr's seminal work, see Symposium, Transforming American Medicine: A Twenty-Year Retrospective on The Social Transformation of American Medicine, 29 J. Health Politics, Policy & L. 557 (2004).

Discussing the relationship between doctors and hospitals, see Symposium, 4 Ind. Health L. Rev. 205-286 (2007);  James F. Blumstein, Of Doctors and Hospitals: Setting the Analytical Framework for Managing and Regulating the Relationship, 4 Ind. Health L. Rev. 209 (2007).

The following excerpts provide additional perspective on historical attitudes about sickness and medicine:

Belief in “nature” and what is natural” is a source of many errors.  It used to be, and to some extent still is, powerfully operative in medicine. …Many practices which have come to seem  “natural” were originally “unnatural”, for instance clothing and washing. …The Chinese philosopher Lao-tse, whose traditional date is about 600 B.C.,     objected to roads and bridges and boats as “unnatural,” and in his disgust at such mechanistic devices left China and went to live among the Western barbarians.  Every advance in civilization has been denounced as unnatural while it was recent.

Bertrand Russell, An Outline of Intellectual Rubbish: A Hilarious Catalogue of Organized and Individual Stupidity 20 (Haldeman-Julius Publications, Girard, Kansas, 1943).

Doctors, Patients, and Health Insurance: The Organization and Financing of Medical Care (1961)
Herman Miles Somers and Anne Ramsay Somers
Reprinted with Permission

Attitudes toward sickness and disability have undergone great changes. Primitive societies ostracized the sick. The ancient Greeks attached a stigma of unworthiness to a sick man. Among the Stoics an incurable disease was held to be sufficient reason or suicide. With Christianity came a sharp change; illness was held to be a grace, "the cross which the sick man carries, following the footsteps of Christ." The care of the ill became a primary concern of the church, and the position of the sick was grad ually raised to the protected status it now occupies in western civilization.

So have attitudes toward medical care shifted over the centuries: from a "blessed benevolence" or a "private luxury," medical care has gradually assumed the status of a necessity and a "civic right." The speed and degree of the most recent change have been so great that we may be said to be living in a veritable "revolution of rising expectations" in regard to health and medical care. . . .

Witness, for example, the ordeal of Charles II of England, which took place as late as 1685:

Once upon a time a king, while shaving, fell unconscious in his bedroom. The following treatment was employed by the royal physicians. A pint of blood was extracted from his right arm; then eight ounces from the left shoulder; next an emetic, two physics, and an enema consisting of 15 substances. Then his head was shaved and a blister raised on the scalp. To purge the brain a sneezing powder was given; then cowslip powder to strengthen it. Meanwhile more emetics, soothing drinks, and more bleeding; also a plaster of pitch and pigeon dung applied to the royal feet. Not to leave anything undone, the following substances were taken internally: melon seeks, manna, slippery elm, black cherry water, extract of lily of the valley, peony, lavender, pearls dissolved in vinegar, gentian root, nutmeg, and finally 40 drops of extract of human skull. As a last resort bezoar stone was employed. But the royal patient died.

When kings could command no better medical care than this, the popular resignation was not only understandable but wise.

The development of scientific medicine has greatly changed this fatalistic view. . . . When Professor Lawrence Henderson identified the period 1910-12 as the Great Divide in United States medical care -- when "for the first time in human history, a random patient with a random disease consulting a doctor chosen at a random stood better than a 50-50 chance of benefitting from the encounter" -- his sharply turned phrase heralded the changing public attitude toward the value of medical care.

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