Chapter 3

The Evolution of Health Services in the United States
Learning Objectives
To discover historical developments that have shaped the nature of the US health care delivery system
To evaluate why the system has been resistant to national health insurance reforms
To explore developments associated with the corporatization of health care
To speculate on whether the era of socialized medicine has dawned in the United States

“Where’s the market?”

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CHAPTER 3

The Evolution of Health Services in the United States

Introduction
The health care delivery system of the United States evolved quite differently from the systems in Europe. American values and the social, political, and economic antecedents on which the US system is based have led to the formation of a unique system of health care delivery, as described in Chapter 1. This chapter discusses how these forces have been instrumental in shaping the current structure of medical services and how they are likely to shape its future. The evolutionary changes discussed here illustrate the American beliefs and values (discussed in Chapter 2) in action, within the context of broad social, political, and economic changes. Because social, political, and economic contexts are not static, their shifting influences lend a certain dynamism to the health care delivery system. Conversely, beliefs and values remain relatively stable over time. Consequently, in the American health care delivery experience, initiatives toward a national health care program have failed to make significant inroads. However, social, political, and economic forces have led to certain compromises, as seen in the creation of Medicare,
Medicaid, and other public programs to extend health insurance to certain defined groups of people. Could major social or economic shifts eventually usher in a