This document discusses several topics related to healthcare systems and delivery. It covers statistics on health outcomes, the history and functions of medical schools and hospitals, different types of healthcare providers like clinics and practices, the various organizations that pay for healthcare, debates around socialized medicine, healthcare access for underprivileged groups, the roles of public health and research, and the doctor-patient relationship. The document considers challenges facing healthcare and potential solutions or improvements across multiple stakeholders and sectors.

1. 1 Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Life Expectancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Mortality Rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Potential Life Lost Years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Infant Mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Amenable Mortality to Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Healthcare Access and Quality Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Healthcare Availability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Healthcare Cost. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Racial Discrepancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2 The Language of Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3 The Medical School. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Medical School Origins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
The Medical School: Mission and Reality . . . . . . . . . . . . . . . . . . . . . . . . . 21
Teaching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Teaching Primary Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Teaching Advanced Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Teaching Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Best of Current Medical Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Medical School Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Costs of Running a Medical School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Medical School Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

2. 4 The Clinic; The Office..................................................................................29
Conclusions.....................................................................................................32
Sources............................................................................................................32
5 The Hospital ..................................................................................................33
History ............................................................................................................34
Pre-twentieth Century.................................................................................34
Twentieth Century Transitions....................................................................34
Hospitals in the Twenty-First Century........................................................36
Hospitals: A Business .....................................................................................40
Conclusions.....................................................................................................40
Sources............................................................................................................40
6 The Practice...................................................................................................43
What Was........................................................................................................44
What Is............................................................................................................47
What Will Be ..................................................................................................49
Conclusions.....................................................................................................49
Sources............................................................................................................49
7 Payers.............................................................................................................51
Ultimate Payer................................................................................................51
Insurers ...........................................................................................................52
Hospital Systems ............................................................................................54
Pharmaceuticals and Medical Instrument Companies....................................56
Summary.........................................................................................................57
The Business of Healthcare ............................................................................58
Conclusions.....................................................................................................58
Sources............................................................................................................59
8 Socialized Medicine ......................................................................................61
Definitions ......................................................................................................61
Single Payer................................................................................................61
Socialized Medicine....................................................................................62
US Healthcare System................................................................................62
Principals and Practices of Socialized Medicine:
The Good and the Bad....................................................................................63
Universal Healthcare...................................................................................63
Equity of Care.............................................................................................63
Exclusions from Care .................................................................................63
Access to Care.............................................................................................64
Quotas.........................................................................................................64
Patient Freedom of Choice .........................................................................65
Physician Freedom of Choice.....................................................................65
Preventative Healthcare...............................................................................65
Use of Medical Care...................................................................................66
Quality of Care ...........................................................................................66

3. Conclusions.....................................................................................................66
Sources............................................................................................................67
9 The Underprivileged.....................................................................................69
Historical Notes..............................................................................................70
Ancient Egypt.............................................................................................70
Ancient China.............................................................................................70
Indian Subcontinent....................................................................................70
Ancient Greece ...........................................................................................71
Ancient Rome.............................................................................................71
Early Europe...............................................................................................71
The USA.....................................................................................................72
The Status of the Underprivileged in Current US Healthcare ........................74
Native Americans........................................................................................74
African Americans......................................................................................75
Hispanic Americans....................................................................................76
Asian Americans.........................................................................................76
Disabled Americans....................................................................................76
Gender.........................................................................................................77
All of Us Are Healthcare Underprivileged......................................................78
Conclusions.....................................................................................................78
Sources............................................................................................................78
10 Public Health and Pandemics......................................................................79
Public Health Definition.................................................................................80
United States Public Health Service and Its Performance..............................80
Public Health and Individual Health...............................................................82
Epidemics and Pandemics ..............................................................................82
Lessons Learned .............................................................................................83
Conclusions.....................................................................................................84
Sources............................................................................................................84
11 COVID-19......................................................................................................85
The Statistics...................................................................................................86
Responsibility .................................................................................................87
Government ................................................................................................87
The Public...................................................................................................87
The Economy..............................................................................................88
Healthcare Agencies and Experts ...............................................................88
What Is SARS-COV-2, the Cause of COVID-19?..........................................89
Beating COVID-19.........................................................................................90
Societal Isolation.........................................................................................90
Vaccines......................................................................................................90
Drugs ..........................................................................................................90
Nature .........................................................................................................90
First Responders .........................................................................................91

4. Conclusions.....................................................................................................91
Sources............................................................................................................91
12 Research.........................................................................................................93
Definition and Origin of Research..................................................................94
Research and Pandemics.................................................................................94
Learning Research ..........................................................................................95
Funding Research ...........................................................................................96
The Soul of Research......................................................................................96
Healthcare Research Upside Down ................................................................97
Conclusions.....................................................................................................98
Sources............................................................................................................98
13 Doctor/Patient Relationship.........................................................................99
The Doctor/Patient Relationship...................................................................100
History ......................................................................................................100
Deterioration of the Doctor/Patient Relationship......................................101
Personal Recollections..............................................................................102
The New World.............................................................................................104
My Doctor, My Patient.................................................................................105
Conclusions...................................................................................................105
Sources..........................................................................................................106
14 Where Do We Go from Here?....................................................................107
Ten Potential Remedies ................................................................................108
Healthcare Workers and Their Leadership................................................108
Advocates of Public Health ......................................................................109
Medical Schools........................................................................................110
Medical and Social Research....................................................................112
Insurers of Healthcare...............................................................................112
Providers: Hospitals and Clinics...............................................................114
Government and Politicians......................................................................114
The Media.................................................................................................115
Philanthropy..............................................................................................115
Everyone...................................................................................................116
Conclusions...................................................................................................116
Sources..........................................................................................................117
Epilogue ...............................................................................................................119
Index ....................................................................................................................121