1. For citations not otherwise noted, see Daniel M. Fox, "Financing Health Services for the Chronically Ill and Disabled: A History of Political Accommodation," Milbank Quarterly 67, supp. 2, part 2 (1989): 257-89, and "Health Policy and Changing Epidemiology in the United States: Chronic Disease in the Twentieth Century," in Unnatural Causes: The Three Leading Killer Diseases in America, ed. R. Maulitz (New Brunswick, N.J.: Rut-gers University Press, 1989). For a general history of these issues, see Fox, Health Policies, Health Politics: The Experience of Britain and America, 1911-1965 (Princeton, N.J.: Princeton University Press, 1986); and Rosemary Stevens, In Sickness and in Wealth: American Hospitals in the Twentieth Century (New York: Basic Books, 1989).

2. Kenneth Ludmerer, "American Medical Education in the Twentieth Century: A Prospectus," unpublished manuscript, 1992, p. 9.

3. For citations on rehabilitation and disability in this period, see Edward Berkowitz and Daniel M. Fox, "The Politics of Social Security Expansion: Social Security Disability Insurance, 1935-1986," Journal of Policy History 14 (Summer 1989): 239-60.

4. The Multiple Screening Idea (New York: Health Information Foundation, n.d. but probably 1952), copy in the Douglas Colman Papers, Empire Blue Cross/Blue Shield Archives.

5. Eli Ginzberg, A Pattern for Hospital Care: Final Report of the New York State Hospital Study (New York: Columbia University Press, 1949), p. 180.

6. The sources quoted in this and the next two paragraphs are in Leona Baumgartner Papers, Organization File to 1962, file labeled "Interdepartmental Health Council," Harvard Medical Archives, Countway Library, Boston.

7. Talcott Parsons, The Social System (New York: Free Press, 1951), chap. 10. This reading of Parsons places him in the context of his time as a social scientist. It contradicts the more frequent reading of Parsons as a normative lawgiver. This is not the place to defend at any length the benefits of using the methods of intellectual history to analyze the social science of an earlier generation. But such a defense would note that Parsons was indebted to Henry Sigerist's classic paper of 1929, "The Special Position of the Sick" (in Henry E. Sigerist on the Sociology of Medicine, ed. M. I. Roemer [New York: MD Publications, 1960]). Sigerist, writing in an earlier generation than Parsons, emphasized that the "goal of medical intervention is the restoration of function." Parsons, observing several decades of popular assimilation of optimistic ideas about medical progress, replaced the concept of function with the much more demanding task of "getting well."

8. Parsons, The Social System, p. 431, n. 7.

9. See pertinent papers in Irving K. Zola, Socio-Medical Inquiries: Reflections, Recollections and Reconsiderations (Philadelphia: Temple University Press, 1983).

10. W. C. Amtz to Elmer B. Staats, February 5, 1960, Record Group 51, Bureau of the Budget Series 51.3a, Box 19, National Archives of the United States.

11. David Bell to John F. Kennedy, March 10, 1961, Record Group 51, Bureau of the Budget Series 61.1a, R5-2/2, Box 45, National Archives.

12. Internal White House correspondence reveals that opposition to crash programs remained strong but ineffective. William Cannon, an official in the Bureau of the Budget, insisted that the activities on behalf of diffusing technology for these diseases "would accomplish little and would actively harm our efforts to keep the NIH budget under executive branch control." Cannon believed that the "problems posed by cancer, heart disease and stroke are primarily research problems" for which NIH already had enough money (William Cannon to Myer Feldman, September 30 and July 26, 1963, Record Group 51, Bureau of the Budget Series 69.1, Box 82, National Archives). For an analogous view, expressed on behalf of community mental health programs as a solution to the problems of the severely mentally ill, see Gerald Grob, From Asylum to Community: Mental Health Policy in Modern America (Princeton, N.J.: Princeton University Press, 1991).

13. Again, this account is based on manuscript sources in the National Archives, which I cite in telling the larger story in "International Perspectives," in Human Resources for Health: Defining the Future, ed. C. M. Evarts et al. (Washington, D.C.: Association of Academic Health Centers, 1992).

14. D. M. Fox, "Sharing Governmental Authority: Blue Cross and Hospital Planning in New York City," Journal of Health Politics, Policy and Law 16 (Winter 1991): 719-46.

15. The evaluators were Arthur D. Little, Inc., and a nonprofit firm called the Organization for Social and Technical Innovation. I was a principal in the latter and principal investigator of the sole-source contract to evaluate CHP. Everything reported in this paragraph is personal observation.

16. Fox, "Financing Health Services." I am indebted to James Maxwell's still unpublished history of Blue Cross in New York for some of what follows. Much of what I say about the Blues and the commercials is a result of documents in the archives at Empire Blue Cross and Blue Shield, notably the papers of Louis Pink and Douglas Colman.

17. Chester J. Pack, Jr., and Elmo Richardson, The Presidency of Dwight D. Eisenhower (Lawrence: University of Kansas Press, 1991), p. 56. See also Gary W. Reichard, Politics as Usual: The Age of Truman and Eisenhower (Arlington Heights, Ill.: Harlan Davidson, 1988), pp. 86-87.

18. Stephen Ambrose, Eisenhower: The President, vol. 3 (New York: Simon and Schuster, 1984), p. 199.

19. For primary sources on the history of Social Security Disability Insurance, see Berkowitz and Fox, "The Policies of Social Security Expansion."

20. For the literature on Medicare and chronic disease, see Fox, "Financing Health Services." The most recent assessment of this issue is Lawrence R. Jacobs, A Social Interpretation of Institutional Change: Public Opinion and Policy Making in the Enactment of the British National Health Service Act of 1946 and the American Medicare Act of 1965. Ph.D. dissertation, Columbia University, 1990; forthcoming as a book from Cornell University Press.

21. John Francis to William Carey, "Events Leading to the Establishment of the Gottschalk Committee," memorandum, March 18, 1968, Record Group 51, BoB file 60.3a, Box 23, National Archives of the United States.

22. John Francis to Pierre Palmer, August 10, 1967, Record Group 51, BoB file 60.3a, Box 23, National Archives; Richard A. Rettig, "Origins of the Medicare Kidney Disease Entitlement: The Social Security Amendments of 1972," in Biomedical Politics, ed. K. E. Hanna (Washington, D.C.: National Academy Press, 1991), 189-90.

23. Sandra Tannenbaum, "Medicaid and Disability: The Unlikely Entitlement," Milbank Quarterly 67, supp. 2, part 2 (1989): 288-310.

24. The leading explanations of our health financing policy are assessed, rather differently, in Fox, Health Policies, Health Politics; Starr, Social Transformation of American Medicine; and several thoughtful works by Hollingsworth, most recently J. Rogers Hollingsworth, Jerald Hage, and Robert A. Hanneman, State Intervention in Medical Care: Consequences for Britain, France, Sweden, and the United States, 1890-1970 (Ithaca, N.Y.: Cornell University Press, 1990).

25. This section is based mainly on research in the Contemporary Medical History Archives of the Wellcome Institute for the History of Medicine, the British Public Records Office, the archives of the British Geriatric Society, and printed public primary sources in the British Library. I have told the story in more detail in "The Perception of Chronic Illness in Health Policy: Britain and America, 1930s-1960s," in Program, Papers and Abstracts for the Joint Conference of the British Society for the History of Science and the History of Science Society (Manchester: BHSS and HSS, 1988).

26. Report of the Ministry of Health for the Year Ended 1945 Including the Report of the Chief Medical Officer of Health on the State of the Public Health for the Year Ended 1945 (London: Her Majesty's Stationery Office, 1946), pp. 77-78, 81, 13.

27. Interview, Bath, United Kingdom, July 1988.

28. In particular see the papers of Sir Thomas Lewis and Sir Edward Mellanby, both in the Contemporary Medical Archives Center, Wellcome Library and Institute for the History of Medicine, London.

29. Rudolf Klein, The Politics of the National Health Service, 2nd ed. (London: Longmans, 1989). I have a special debt to Professor Klein as a result of many conversations with him about health policy in the United States and the United Kingdom.

30. A notable publication that discusses the "young chronic sick" is Separation of Younger from Older Patients in Hospitals (London: Her Majesty's Stationery Office, 1975).

31. King's Fund Commission on the Future of London's Acute Health Services, London Health Ca re 2010: Changing the Future of Services in the Capital (London: King Edward's Hospital Fund for London, 1992). An official commission soon recommended that the government accept most of the recommendations by the King's Fund Commission. See Sir Bernard Tominson et al., Report of the Inquiry into London's Health Service, Medical Education and Research (London: Her Majesty's Stationery Office, 1992).

32. I am grateful to Dr. Michael Ashley-Miller, secretary of the Nuffield Provincial Hospitals Trust, for conversations that bear on this paragraph.