Chapter 6: Escape From the Corporation (1900 - 1930)

a. I was surprised to learn that the railroads were the foremost industry when it came to medical care programs for their employees. However, when the author mentioned the high rate of injuries among railroad workers, this made sense. I also was surprised to learn that employee medical programs also expanded and included such services as schools, housing, and social and religious programs. The goals of such programs were two-fold; to encourage morale among workers, and to encourage loyalty to the company.

b. I agree with physicians who were reticent to accept interference or rule by private corporations and government. The idea of one's profession (be it medicine or otherwise) becoming mediated or even controlled by corporations is intimidating. Such relationships can have benefits, for both the physician and the industry or government, such as cooperative teamwork, guaranteed contract work for physicians, and decreased rates of labors for the corporation. However, other concerns, such as lowered quality of medical programs or care, and increased competition due to reduced rate services are understandable, as well. While autonomy was important, mediating corporations could also make a profit from their services, which would no doubt cut into the profits of physicians, adding to the concern.

c. I do not agree with Starr's statement, in reference to the rapid advances of medicine through new technology and antibiotics, that "the chief threat to sovereignty of the profession was the result of this success." I believe that the chief threat to sovereignty was largely due to costs. The growing population, rising costs of medicine, and new precedents of such practices as employer provided health care plans all contributed to the emergence of management organizations.

d. Something I have noticed in my experiences, which Starr mentions, is the introduction of a third party to medical care to curtail rising costs. Today, nearly 30% of health insurance coverage falls under HMOs. Starr mentions that by the second half of the 19th century, it became clear that the use of third parties in care would be unavoidable. In 1973, the Health Maintenance Organization Act was passed, which precipitated expansion of HMOs throughout the country.

e. One thing I am interested in learning more about is the shift from individual practice to mediation by corporations and the government. We have learned about HMOs in this course. In the early 1900s, physicians were hesitant to cooperate with corporations to provide care, but this attitude seems to be shifting. This is likely due to practicality, due to the large presence of HMOs and government programs such as Medicade and Medicare in medical care.