ABSTRACT
In 1967, in President Johnson’s budget message to congress he proposed a quadrupling of federal spending on health care and medical assistance for the poor, to $4.2 billion in fiscal 1968. People with higher incomes have a tremendous advantage in the use of medical specialists—27.5 percent see at least one of them annually, compared to about 13 percent of the poor. Medical care, as know it, is closely linked with the advancing organization, complexity, and maturity of society and the increasing education, urbanization, and need for care of people. The very massiveness of modern medical organization is itself a hindrance to health care for the poor. Large buildings and departments, specialization, division of labor, complexity, and bureaucracy lead to an impersonality and an overpowering and often grim atmosphere of hugeness. The poor, with their meager experience in organizational life, their insecurity in the middle-class world, and their dependence on personal contacts, are especially vulnerable to this impersonalization.
