The Evolution of the U.S. Healthcare System

Between the years the beginning of 19th century and today, healthcare in the United States evolved from a simple system of home remedies and itinerant doctors with little training to a complex, scientific, technological, and highly bureaucratic system. The system is built on medical science and technology and the authority of medical professionals. Its evolution includes the acceptance of the "germ theory" as the cause of disease, professionalization of doctors, technological advancements in treating disease, the rise of great institutions of medical training and healing, and the advent of medical insurance. Governmental institutions, controls, health care programs, drug regulations, and medical insurance also evolved during this period. Most recently, the healthcare system has seen the growth of corporations whose business is making a profit from healthcare.

Prior to 1800, medicine in the United States was a "family affair." Women were expected to take care of illnesses within the family and only on those occasions of very serious, life threatening illnesses were doctors summoned. Called "domestic medicine," early American medical practice was a combination of home remedies and a few scientifically practiced procedures carried out by doctors who, without the kind of credentials they must now have, traveled extensively as they practiced medicine.

Until the mid-eighteenth century Western medicine was based on the ancient Greek principle of "four humors"—blood, phlegm, black bile, and yellow bile. Balance among the humors was the key to health; disease was thought to be caused by too much or too little of the fluids. The healing power of hot, cold, dry, and wet preparations, and a variety of plants and herbs, were also highly regarded. When needed, people called on "bone-setters" and surgeons, most of whom had no