Community Hospitals

“Despite the equation of science, voluntarism, and democracy, then, and despite belief in the superiority of American innovation and technology over the supposed rigidity of foreign governmental health-care systems, American hospital service was both inegalitarian and structurally rigid. Indeed, in the 1950s insurance coverage divided the middle class clearly from the indigent. The latter’s care was covered by public assistance (in whole or in part), by cross-subsidy within the hospital, or occasionally by free care from hospital endowments or gifts. The postwar building boom allowed hospitals to provide hospital care, wherever possible, to private patients in single rooms, 2-bed rooms, or at most 4-bed rooms – but not for everyone (Stevens II, 253). . . . Hill-Burton allowed for the segregation of patients by race and for the continuation of the multiclass system (254). . . . During the 1950s, although the voluntary hospital became a center for community aspirations write large, these aspirations were varied and conflicting. American wanted unlimited technology, access to it by the whole population, and a service that was affordable to all –all without recourse to a governmental system. It was not possible to achieve all these goals simultaneously. The policy of community, vague though it was, conflicted with social expectations about equity of access, with the cherished prerogatives of local doctors who saw the hospital as their workshop, and with the autonomy of the local voluntary institution as a center for private charity-giving” (255).