in that it is embedded in the federal government, in
the states, and in local government. On the federal
level, the Department of Health and Human Ser-
vices is supported by federal agencies that deal with
one or another aspect of citizens’ health, such as the
Veterans Administration, the Department of Labor’s
Occupational and Health Administration (OSHA),
the Bureau of Mines in the Department of the Inte-
rior, and the Department of Agriculture, which pro-
tects farmers and animals from harm in the field.
The federal government essentially provides grants
and loans to state and local governments and to uni-
versities, and it issues guidelines on health, such as
the code of ethics for physicians. Thus, states and
local governments are the main implementers of
health care laws in the United States, administering
Medicare to senior citizens and Medicaid to the
poor through their health and social work depart-
ments and local boards.
Parallel to the federal government, state and local
institutions, and agencies exist voluntary organiza-
tions such as the American Cancer Society, the Amer-
ican Red Cross, the American Medical Association,
and the American Public Health Association. All of
these organizations promote health awareness and
recommend policies. Private businesses also per-
form various health functions. These include physi-
cians’ clinics and industrial plants with their own
health care facilities designed to protect their work-
ers (such as in the mining, railroad, and lumber in-
dustries).
Since the 1980’s, the health care system has been
overwhelmed by for-profit, private market-driven
corporations, powerful pharmaceutical companies,
health insurance companies, and a wide spectrum of
hospital ownership and management. Administra-
tors of programs for the poor, such as Medicaid,
and an increased number of physicians and nurses
groups have become directly involved in lucrative
health care.
The Health Revolution of the 1980’s During the
1980’s, the health care system experienced an ex-
pansion determined mostly by profit-minded corpo-
rations, government efforts to cut the cost of health
care, and a capitalist philosophy that the private sec-
tor was better suited than the government to provide
advanced, effective, and financially cheap health
care. The move forced many states to experiment
with several new health plans that relegated health
care to private or proprietary companies and agen-
cies. This led to the emergence of powerful HMOs,
which had been authorized by Congress through the
Health Maintenance Organization Act of 1973. In
the 1980’s, HMOs had a membership of 28 million
Americans.
The number of medical colleges for the training
of physicians rose to 127, or 1 per 1,920,000 people
(or to 142, if osteopathic schools are included).
Medical students completed their training in four
years following a baccalaureate degree and were re-
quired to spend one paid residency in a hospital,
with specialization in one of the health fields. By
1985, 85 percent of new physicians had specialties.
In 1986, there were 218 physicians per 100,000 pop-
ulation, compared to 150 per 100,000 during 1900
to 1910. Also, the number of nurses, many of whom
had to complete at least two years of academic train-
ing, skyrocketed to 666 per 100,000 among affluent
Americans. During the decade, women and minori-
ties began to enroll in medical schools in relatively
large numbers. Only 5 percent of women were in the
medical field in 1950, and by 1983 this figure had
risen to 33 percent.
The number of drugstores had reached 51,000 in
1980, estimated as one per 4,700 Americans, with
many experts claiming that the number was exces-
sive. The number of pharmacists stood at 55 per
100,000 in 1985. By 1986, the number of dentists, a
fast-growing health care group working with for-
profit organizations, reached the ratio of 57 per
100,000. In 1981-1982, there were 6 hospital beds for
every 1,000 population, with hospital admissions of
158.5 per 1,000 on the average and an average
length hospital stay of eight days. Eventually, the
number of hospital beds reached 6,500 as a result of
demographic growth and the aggressive drug adver-
tising by pharmaceuticals and physicians. During
that decade, among the 75 percent of the hospital
beds privately owned, 15 percent were administered
by not-for-profit religious or nonsectarian organiza-
tions and 10 percent were proprietary or for-profit.
The government virtually gave up control of nurs-
ing homes, convinced that relegating them to the
private sector would result in substantial cost reduc-
tions and improved overall management and ac-
countability. In 1980, moreover, the number of gov-
ernment-run hospitals accounted for only 4 percent
of the total, while 15 percent were under religious
and not-for-profit organizations, leaving 81 percentThe Eighties in America Health care in the United States 449