The health care crisis in the United States has roots that reach into the nineteenth century. An examination of the cultural, social, and economic roots should warn against piecemeal and short‐range measures to correct a fragmented system which, despite all its achievements, is draining the economy while it fails to meet the needs of millions. Unlike the Western European experience, it began as a loosely organized and loosely co‐ordinated system, responding as it grew to the forces of change: research from Europe, technological advances, corporate interests, the need for a healthier labour force, and the economic stimuli of the marketplace. Throughout the centuries, the delivery of medical care was seen in the terms of the buying and selling of a commodity. Professional and corporate groups are interested in keeping it essentially as it is by emphasizing its accomplishments and predicting setbacks of all kinds if drastic change is made. Argues that if the reformers in and out of government do not recognize the roots of the problems and the pivotal points requiring radical surgery, they will be unsuccessful in bringing about a more comprehensive and efficient health care system. A final lesson of history is that health care is a much broader reality than medical care. The health of the people depends largely on the improvement of the social and natural environment.
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