The success of American medicine is often attributed to the profession\u27s ability to serve the public on its own terms. Why should doctors care if, from the patient\u27s point of view, the terms chosen--solo practice and emphasis on the doctor-patient relationship --mean that a doctor performs unsupervised services for unregulated fees? What does it matter to them that the poor are outside the system altogether, treated in charity wards or public hospitals which are the medical equivalent of Andrew Carnegie\u27s libraries, a small concession to charity from an accelerating machine of wealth, power, and influence? In a country proud of its pluralism and fearful of government interference, a monolithic self-regulating profession is taken as a sign of health. Few people are persuaded that medical care is a fit object of social planning: We have no national health policy and we are mostly proud of it
