The Destabilization of Health Care

Abstract

During the past 15 years, there have been many signs of the increasing destabilization of the health care system in the United States. Between the Flexner report in 1910 and the beginning of the 1970s, a period of six decades, the system had been characterized by a remarkable stability that reflected three factors: the dominance of the medical profession; local sponsorship of community hospitals; and the practice of cross-subsidization, which enabled physicians and hospitals to care for many of the poor by overcharging the affluent. The established system could adjust to new opportunities, and the underlying structure protected and fostered . . .