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This chapter examines both the promise and paradox of care at PubliCare Hospital. On the one hand, practitioners' deep commitment to the provision of care as a right gave the facility a special character. On the other hand, these same commitments seemed to go hand in hand with a lack of role differentiation or organizational structure that lef the organization in a constant state of disarray and financial peril. The chapter shows that, among practitioners across the three hospitals in Las Lomas, those at PubliCare struggled most with how to reconcile a right to health care with care as a commodity to be sold. It also considers PubliCare Hospital's “socialized medicine” for desperate and despairing patients, what is unique about PubliCare physicians and nurses, and vocational commitment and creativity at the hospital. Finally, the chapter explains how the mission of health care at PubliCare seemed to be at odds with the market for care.

The American health care industry could not have reached its present size and vitality without a foundation of government support. No other entity has the resources and national perspective needed to buildand maintain the infrastructure on which it rests. However, the resulting public-private partnership also has its share of failings. Public largesshas created private sector behemoths that perennially lobby for new regulatory favors and ever greater levels of funding. The extent of this dynamic is distinctive among developed countries, and it has caused America’s private health care sector to be the largest and the system’s costs to be the highest of any. It has also kept the full magnitude of the government’s role largely hidden from public view. This has engendered widespread misunderstanding of the system’s true nature and skewed political debates over reform.

In 1950, the newly chosen US senator, Frank P. Graham, ran to be elected for a full term in the Senate. Although Graham had no experience in politics and refused to run a traditional campaign, his backers assumed he would win because of the enthusiastic support of the Scott administration and the farm, black, and labor vote. The conservatives in the state, fearful of Graham’s liberal tendencies, supported Willis Smith, a highly successful attorney. Smith, aided by big business, the power companies, and the banks, began to attack Graham for supporting socialized medicine and a compulsory fair employment practices commission. He accused Graham of Communist leanings because of his association with many subversive organizations. Smith made Scott an issue in the campaign for violating traditional neutrality in the party by supporting Graham. Graham was the “hand-picked” candidate of Scott and Truman—the “would-be dictators” of North Carolina. Scott and others fought back and defended Graham, but the contest changed when the Smith forces realized that they could not win on anti-Communist charges and shifted their emphasis to race. A series of racist ads helped change the momentum in the race. Although Graham won the first primary, he fell 5,634 votes from winning 50 percent of the vote.

This chapter describes the political controversy accompanying the decision to launch the U.S. Veterans Bureau (now the Department of Veterans Affairs) during the Harding administration in 1921, its implementation problems between August 1921 and March 1923, and its rapid shift to normalization in 1923–24. It seeks to answer the questions of how and why, in the business-oriented Harding administration of 1921, the United States established a huge government organization that developed a system of federal hospitals and health care for veterans. Government reorganization to provide business efficiency was the initial strategy. But charges against the bureau's first director, from mismanagement to corruption, deflected attention from broader questions. Under its second, business-oriented director, the bureau, with its “socialized” veterans’ hospital and health care system, was stabilized as an enduring American institution under the rhetoric of management efficiency.

Chapter 6 considers the roots of the mortality crisis that many postsocialist countries faced in the 1990s and the declining life expectancies that some countries continue to face, while others have increased dramatically. It shows how privatization dismantled socialist health care systems leading to significant deteriorations in health outcomes in some countries and how the privatization of previously state-run breweries and distilleries and deregulation of sales led to increased alcohol consumption. The chapter also evaluates rampant alcohol dependency and abuse as a significant factor in declining life expectancy and increasing mortality rates, and points to the psychosocial stress of transition as a major root cause for alcoholism, cardiovascular disease, and suicide.