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This chapter looks at how the federal government and private insurers began setting limits on the amount of money they were willing to pay for medical care. Under legislation enacted in 1983, hospitals began receiving a set fee for Medicare patients based on their diagnoses, regardless of how much it actually cost to treat them. Another challenging development was the rise of managed care. Under this system, third-party payers, such as employer-sponsored health insurance plans, attempted to reduce medical costs by limiting the number of hospitalizations and the use of specialists by member patients. These health care trends threatened New York Hospital, Cornell University Medical College, and by extension, Cornell University. As the New York Hospital–Cornell Medical Center struggled to handle these challenges throughout the 1980s, relations between the hospital and medical school continued to deteriorate.

This chapter explores how Cornell University Medical College (CUMC) joined with New York Hospital between 1928 and 1934 to construct a new medical center on the Upper East Side, creating a greater integration of clinical, research, and teaching activities. The medical center's cornerstone was set on June 12, 1930. In a volume of the student-run Cornell Daily Sun, G. Canby Robinson, director of the New York Hospital–Cornell Medical College Association, wrote in enthusiastic terms of the affiliation between CUMC and the New York Hospital. His idealism was not just confined to the expansive possibilities presented by the affiliation; much of his correspondence conveyed a deep-seated belief in the power of medicine, not just to heal bodies but also to inspire a love of mankind and of service to humanity.

This chapter explains that the term “malaise” is frequently used to describe the 1970s, a decade generally remembered for its economic and political woes. The United States was plunged into a deep recession in 1973. Medical schools, hospitals, and the health care system were certainly affected. Health care costs escalated rapidly, and the public became increasingly aware of factors that were contributing to a rise in chronic conditions. University medical schools like Cornell University Medical College were forced to tread a fine line between charting a socially responsive course and maintaining a commitment to academic scholarship. By the end of the decade, the situation at Cornell had turned dire. Serious reservations regarding the quality of its students and faculty had emerged, relations with New York Hospital had taken a turn for the worse, and financial problems appeared insurmountable.

There are whole districts in Manhattan, Brooklyn, and the Bronx that operate as medical cities at the highest level of biomedical research as well as clinical facilities for patients. Bellevue Hospital, New York Hospital, New York University School of Medicine, Sloan Kettering, Mount Sinai, Weill Cornell, the Bronx VA Medical Center, Albert Einstein College, SUNY Downstate Medical Center, New York Presbyterian/ Columbia Medical Center, and The Rockefeller University, just to mention some of the best known among them. They are all producers of new knowledge from basic biology to bedside medicine. Handling and eradicating illnesses of epidemiological scale are among their spectacular successes.

Chapter 2 introduces the activists whose endeavors are the focus of the rest of the study. Future leaders of the empire of humanity, such as Caribbean-born Quaker John Coakley Lettsom, who lived his adult life in London, and the Edinburgh-educated Philadelphian Benjamin Rush, were born in the 1730s, ’40s, and ’50s. From their youth, they participated in the project of building a single, coherent Atlantic community. That orientation and their own personal experiences as they made their way around the Atlantic world for schooling, training, and jobs laid the foundation for all their later philanthropic activity. To provide the reader with an understanding of the base that the book’s subjects built on, the chapter surveys the charitable landscape of the urban British Atlantic world in the 1760s. It ends with a look at two charities that reveal tensions and bonds within the transatlantic community as the imperial crisis developed.

This chapter focuses on the deanship of Vernon W. Lippard, a Massachusetts native who had taken the five-year combined medical course in the Sheffield Scientific School, receiving his M.D. degree cum laude in 1929. One of five students elected to membership in the medical honor society, Alpha Omega Alpha, he was also awarded the Parker Prize, given annually to the graduating student “who has shown the best qualifications for a successful practitioner.” During his final year, the first issue of the Yale Journal of Biology and Medicine was published, and it contained two abstracts, based on articles by faculty members, signed “V.W.L.” After graduating, Lippard remained in New Haven for an internship in pediatrics with Grover Powers at the New Haven Hospital. He then went to Cornell for residency training and was the first chief resident when the Cornell Department of Pediatrics moved to the newly completed New York Hospital in 1932.