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My topic, health care in the early 1960s, has a double set of meanings for me. I am a historian, and the 1960s are now "history," ripe for new interpretations. Yet I was also an immigrant to the United States in 1961, fresh from working as an administrator in the British National Health Service. The period immediately before the Medicare legislation in 1965 shines in my memory with the vividness of new impressions: those of a young health care student trying to make sense of the U. S. health care system, and indeed, of the United States.
The health care system and the United States as a society stand, in many ways, as proxy for each other, now as then: The whole tells you much about the part, and the part about the whole. In the early 1960s, health care was already a massive enterprise. By the late 1950s, hospitals employed far more people than the steel industry, the automobile industry, and interstate railroads. One of every eight Americans was admitted annually as an inpatient (Somers and Somers, 1961). To study health care, with all its contradictions and complexities, in the 1960s as in the present, is to explore the character and ambiguities of the United States itself, that vast, brash, divided yet curiously hopeful Nation.
On the face of it, the United States was a country blessed by plenty in the 1960s, with hospitals and professionals that were the envy of the world. Among the marvels of modern hospitals that provoked comment from a visiting delegation from Britain in 1960 were complete air conditioning and artificial lighting systems, adjustable electric beds, carpets in private rooms, pass-through refrigerators in the kitchen, central milk kitchens, central sterile supply services, automatic X-ray processors, autoanalyzers in the laboratory, plastic bags for blood, identification bracelets for patients, pneumatic tube systems for communications and, not least, massive power plants (Hurst, 1960). In the United States, the hospital was readily compared with industrial corporations.
Yet the gaps and variations in both rhetoric and service were extraordinary. To the new migrant, the vast cross-continental network of superhighways appeared to connect cities-indeed swept through, around, or over them-without stopping to recognize their problems, character, or differences. Similarly, in both the larger society...