Walton H. Hamilton, an economist, wrote an essay on the future of medicine. He tried to get at the question of where the physician fits in economically into modern society.
Hamilton painted a picture of what private practices were like around 1900. Doctors charged according to what individuals could pay. Medicine was seen as a public service, and doctors frequently had to pinch pennies to survive.
Then medicine became a business, and it soon became a good business. However, Hamilton’s view was that it couldn’t possibly be a rational business because the average layman simply doesn’t know enough to make an informed choice. He can’t really shop for the best care.
And, if medicine is a business, it has to acknowledge that it’s going to have competitors in the free marketplace. It must recognize that some people will believe that crystals, spells and prayers should have at least equal standing with insulin, diagnostic tests and surgical procedures.
If medicine is a business, it needs to get over the notion that it can regulate its competitors out of business.
Hamilton concluded that the business model was wrong-headed and poisonous. He said we needed a national health service, similar to public education. The service must be publicly funded and mandatory — no opt outs.
His article was published in 1932.
• Source: Hamilton’s essay was a dissenting view in Medical Care for the American People, the majority report of the Committee on American Medicine. The report was published by the University of Chicago in 1932.
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