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

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).

On medical professionalism, Eliot Friedson's latest work is Professionalis: The Third Logic (Univ. Chicago Press, 2001).  A book review symposium on this work is at 28 J. Health Politics, Policy & L. 133 (2003).

Updating some of the figures in the Joseph White article, in 2003 the median income for primary care physicians was about $157,000, and for general surgeons, about $265,000. 

The following excerpt provides additional perspective on historical attitudes about sickness and medicine:

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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