Remaking the American Patient: How Madison Avenue and Modern Medicine turned Patients into Consumers

From a comparative perspective the health system of the United States has a history that is both representative and idiosyncratic. Like other advanced industrial nations, it witnessed the rise of biomedicine to professional dominance in the later 19th century, followed by the transformation of the hospital into a temple of high-tech healing, the growth of a pharmaceutical industry ministering to body and mind, and organized structures of access that combined insurance, public funding and private payment. It has been in the balance between these different modes of financing that the disparity between American health care and its peers has been most observed. Unlike other Western nations, which followed either Bismarckian Germany in instituting compulsory health insurance, or inter-war New Zealand in developing a comprehensive state health service, America repeatedly placed more faith in private enterprise. Until relatively recently its doctors exercised greater liberty to practice and charge as they wished, while its commercialized health insurance industry remained voluntary, and its public sector, in the form of Medicare and Medicaid, which arrived only in the 1960s, was limited in coverage to older people and the poor.