In sickness and in wealth : American hospitals in the twentieth century

444 Pages·8.218 MB·English

by  Rosemary Stevens.

In Sickness and InWealth
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IN SICKNESS
AND
IN WEALTH
American Hospitals in
the Twentieth Century
ROSEMARY STEVENS
BasicBooks
A Division of HarperCollinsPublishers
Table 10.3 reprinted courtesy of Charles C Thomas, Publisher, Springfield, Illinois.
Table 11.2 copyright ® Blue Cross and Blue Shield Association. Used with permission. All
rights reserved.
Library of Congress Cataloging-in-Publication Data
Stevens, Rosemary.
In sickness and in wealth.
Includes index.
1. Hospitals—United States—History-
20th century. I. Title. [DNLM: 1. Hospitals—
History—United States. WX 11 AA1 S8i]
RA981.A2S74 1989 362.1'1'0973 88-47903
ISBN 0-465-03223-0 (cloth)
ISBN 0-465-03224-9 (paper)
Copyright © 1989 by Basic Books, Inc.
Printed in the United States of America
Designed by Vincent Torre
90 91 92 93 CC/RRD 9 8 7 6 5 4 3 2 1
Q. You can not put doctors and ministers who are engaged in the distribution of
sweet charity in the line of men who are managing Standard Oil and the Sugar
Trust.
A. I think human nature is the same.
Hearings in the Pennsylvania legislature
on state (tax) aid
to nongovernmental hospitals, 1910
After all, the chief business of the American people is business. . . . We make no
concealment of the fact that we want wealth, but there are many other things that
we want very much more. We want peace and honor, and that charity which is
so strong an element of all civilization. The chief ideal of the American people is
idealism.
Calvin Coolidge, speech to the American Society
of Newspaper Editors, 1925
The modern hospital, whether operated by a city, a church, or a group of private
investors, is essentially a business.
Parker v. City of Highland Park, Michigan,
on hospital tort liability, 1978
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CONTENTS
ACKNOWLEDGMENTS Xi
1. Introduction 3
American Dilemma: Technological versus Social-Welfare Goals
Characteristics of the American Hospital System
The Process of Change
Charities and Businesses: Hospitals in the Early

Twentieth Century 17
Establishing the Power Base: Patterns of Allegiance
Charities as Businesses: The Pay System
The Public Role of Private Hospitals
The Hospital as an Instrum, it of Progressive Ideas
A National Enterprise: Setting Basic Rules 52
Scientific Medicine as a Basis for Authority
Standardizing Medical Education
Hospitals and the Internship
Regulating Hospitals: A Posse of Players
Hospital Administrators and Scientific Management
Coming to Grips with Standards in Surgery
4. The Case for Cooperative Medicine: World War I 80
Organizing Medicine for the Service of Patients
The Health-Insurance Movement
Hospitals at War
Influence of Wartime Practices at Home
Nursing as Patriotism Made Visible
Military Men and Civilian Institutions
A "Negative Instrument of E-Alution"?
5. Hospitals in the 1920s: The Flowering of Consumerism 105
Constructing the Consumer Institution
Standardization Is Achieved—Within Limits
viii Contents
Consumers and Communities
The Public Power of Private Interests
Problems and Limits of a Marketplace Ethos
6. The Political Creation of the Voluntary Ideal: Hospitals
During the Depression and the Early New Deal 140
Hard Times
Defining Hospital and Medical Interests Against the Threat of Government
Domination
Hospital Administration as a Profession
Carving Out the Middle Ground: The Voluntary Sector
Hospital Associations as Political Lobbies
The Political Utility of the Voluntary Ideal
7. Technology and the Workers: The Genesis of Blue
Cross 171
The Necessary Institution
The Technological Bureaucracy
Beginnings of Group Hospitalization
Blue Cross and National Policy-making
How Should Hospital Technology Be Distributed?
Policies and Politics in the Late 1930s
8. Consolidation Without Jeopardy: Planning in the
Shadow of World War II 200
Hospital Medicine as Medical Science
A Knowledge-Based System?
Wartime Programs and Their Implications
Laying the Base for Postwar Planning
Hospital Planning: Consensus from Within
The Hill-Burton Act: Expansionism and Independence
Hospital Planning and the Voluntary Ethos
Planning as a Process, Science as a Mission
9. Pillars of Respectable Independence: The 1950s 227
Government Policy-making by Incentives
The Community Institution
The Industrial Model of Organization
Hospital—Medical-Staff Relations
Hospitals and the Quality of Care
Emergence of Larger Community Interests
Contents ix
10. The Drive for Reimbursement 256
Hospital Financing: Largesse and Limitations
Blue Cross on the National Scene
Selling Hospital Services to Government
New Elements in the Public-Private Mix
Is Voluntary Planning Feasible?
Medicare: The Watershed
11. Pragmatism in the Marketplace: 1965-80 284
Medicare and Medicaid Are Implemented
Capital: The Keystone of the Arch
Planning and the Politics of Debt
The Death of Charity?
New Alignments by 1980
12. Hospitals at the End of the Twentieth Century 321
The New Standardization: Federal Control
Quality: A Question of Measurement or a Question of Trust?
Hospitals as Businesses
Redefining the Workshop: Hospitals and Doctors
Voluntarism Redux: Charity and Tax Exemption
Ironies and Inconsistencies
13. The American Hospital System in Historical
Perspective 351
Ideals and Ideology in Hospital Policy
Coping with Ambiguity
The Not-for-Profit Sector
What Next?

NOTES 367

INDEX 419
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