Medicare, Medicaid, and Medical Education
With the passage in 1965 of Medicare and Medicaid, a new era began—one in which the clinical activities of medical schools began to hypertrophy, swelling out of proportion to their other duties. This effect was not expected at the time Medicare and Medicaid legislation was enacted, nor did it happen immediately. Nevertheless, in the years that followed, clinical service rapidly grew to become their most conspicuous activity and most important source of income. In the process, their link to the university weakened, their commitment to academic values decreased, their tradition of charity eroded, and they became enmeshed more firmly than ever in the health care delivery system. If research had once been the master, that role at most medical schools was increasingly assumed by patient care—to the increasing subordination of both research and teaching.
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