The history of health care and public health in the United States is every bit
as interesting and is certainly more revealing than would be a mere snapshot
of current struggles and social dynamics. After all, the social institutions and
processes that currently constitute the mammoth edifice we call health care
have their origins in America's tumultuous history. In the course of the de-
velopment of our democratic capitalist economy, the institutions of health
care have been radically transformed by revolutionary social processes.
Today's health care institutions are built on these historical processes. In
fact, one could easily demonstrate that today's health care struggles emerge
from social forces unleashed by the Civil War over 130 years ago. An under-
standing of the social dynamics of health care in the United States today is
impossible without an awareness of how these dynamics burst forth from the
past and of how they took their present form. This chapter provides a brief
overview of the historical emergence of both medicine and public health in
the United States. From that foundation the narrative proceeds through an
initial discussion of three fundamental issues: health status, the cost of health
care, and the politics of health care.

Until approximately the last decade of the 1800s, women in the household
ministered to most of the births and other health and medical needs of their
families. In this system of domestic health care, they were typically not paid
for their services. They performed these services strictly for their "use value,"
that is, principally because all concerned believed that the health care pro-
vided was beneficial. They received most of their information from older
women who were living repositories of medical folklore. During most of the
1800s the oral tradition of folk medicine was largely supplemented by a vari-

-1-