This is the first of a 2-part series. You may find part 2 here
Q: What is the starting point in the history of the American health care system?
A: The American health care system was born in the 1910’s out of the so-called “Flexnerian reform” in medical education and the resulting licensing laws.
Q: Why is that the starting point?
A: Prior to that time, medical care in the United States was essentially unregulated. Anyone could open up a medical practice, and many did so with little training.
Patients had complete freedom to obtain medical care from whomever they wished. When such complete freedom exists, one cannot realistic talk about a “system.”
Q: What were the main features of this “pre-historical” period?
A: There were competing forms of medical care. “Regular” medicine continued the tradition emanating from European institutions and medical schools. It was ostensibly represented by the American Medical Association (AMA).
The regular form of medical care tended to be more disposed toward aggressive interventions (blistering, bloodtletting , and toxic purgatives), but over time, it also increasingly incorporated scientific knowledge into its mode of practice. Surgery was part of regular medicine, and surgical techniques were improving rapidly in the latter part of the nineteenth century.
Other forms of medical care, such as Eclecticism, herbalism, and homeopathy tended to be less inclined toward aggressive treatments, and each had its own diagnostic and therapeutic philosophy.
There was a multitude of medical schools, and most of them were privately owned. In many cases, the curriculum lasted one or two years after high school. Given this large number of schools, the United States had the highest number of physicians per capita in the world.