possible. Thomas Parran himself was relieved of his position as Surgeon General and replaced by the more malleable Leonard Scheele. There was no lack of money to spend. In 1946, the Hospital Survey and Construction Act, or Hill-Burton program, was passed to finance the construction of community hospitals, initially providing $75 million a year for five years, and eventually pouring $3.7 billion into new hospital construction. The Hill-Burton program was strongly supported by the American Hospital Association and the American Medical Association; it provided new facilities for medical practice without threatening in any way the method of paying for health services. Indeed, Hill-Burton had a specific provision prohibiting federal involvement in setting hospital policy.38 The system of Veterans Administration hospitals was also greatly expanded and tied in more closely to local medical schools.

Scheele had earlier been associate director of the National Cancer Institute and was now, as Surgeon General, responsible for the National Institutes of Health. Like hospital construction, medical research had many friends and seemingly no enemies. Cancer and heart institutes had been the first, mental health and dental institutes followed, and then came a succession of other special institutes targeted toward a specific disease (diabetes, arthritis), body part (eye, kidney), or stage in the life cycle (child health, aging). The institutes grew and grew wealthy; they also gave away most of their funds to universities and medical schools in the form of research grants. Because the medical schools and the American Medical Association had opposed the direct provision of federal funds to medical education—nursing an avid suspicion of any form of governmental intervention or control—the NIH research grants proved a politically acceptable way of funneling money to the medical schools. No federal bureaucrats were deciding the dollar amounts given to a particular school: grants were awarded on the decisions of peer review committees composed of non-federal experts in the particular field of research. Liberals, conservatives, medical school deans, and researchers were all happy with the system, and members of Congress were pleased to bankroll such a popular and uncontroversial program.39

Schools of public health would have had no objection whatsoever to direct federal funding—assuming only that it were relatively generous. But public health schools were generally lumped in with medical schools

38  

Paul Starr, The Social Transformation of American Medicine. New York: Basic Books, p.p. 348–351.

39  

Stephen P. Strickland, Politics, Science, and Dread Disease: A Short History of United States Medical Research Policy. Cambridge, MA: Harvard University Press, 1972. See also Eli Ginzberg and Anna B. Dutka, The Financing of Biomedical Research. Baltimore: The Johns Hopkins University Press, 1989.



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