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Nationally sponsored programs designed to fund health care for the general public are largely a twentieth century phenomenon. Yet a long glance backward at the medical and public health history of Western civilization, extending from the ancient Greeks to the twentieth century, reveals earlier periods when governments, religious institutions, and other groups provided some measure of medical relief for the sick, the poor, and the homeless. In this essay, I will provide not an exhaustive but rather an illustrative account of this oft forgotten fact. My objectives are threefold.

First, to remind us that the active concern of society for the health of its citizens is hardly a new development arising full born, as it were, out of the biomedical revolution and refined moral sensibilities of our present age. As I will suggest, our current interest in public health, and the related question of how to allocate medical resources fairly, is part of a larger evolutionary social process. Second, to conjecture that the impulse of caring for the sick and injured, using public or private resources,1 is typically driven by a variety of sometimes overlapping motivations, both religious and secular in origin. Third, to indicate that no single monolithic philosophy of providing medical care for the masses emerges from the historical record. That is, no unified pattern of health care organization or individual or communal motivation can plausibly account for this seemingly altruistic behavior, behavior which is putatively aimed at promoting the common good of all members of society.

Given the interdisciplinary scope of this discussion, my inquiry will weave together sociological, psychological, and philosophical strands of evidence. Constraints of length will limit us primarily to developments in Europe and the United States. In the end, a limited sampling of societal practices, individual or communal motivations, and philosophical considerations will indicate that no simple story can be told about the public or private funding of health care.

Proceeding more or less chronologically, I will introduce evidence demonstrating that redemptive, utilitarian, prudential, and charitable impulses (among others) are at work in the humane decision to use public or private funds to provide medical care for the benefit of the sick or infirm. While I do not claim that these four motivations constitute a complete list, they do emerge as a recurring and significant typology — helping to solidify the emerging modern public health movement in England, the United States, and elsewhere in the West by the late nineteenth century.




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