The Flexner Report: Medical Fascism Comes to America

Everyone can agree that America’s health care system is seriously flawed.  What people disagree about is the solution.  Because Americans think of themselves as having a capitalist economy, they assume that the free market is the cause of their problems and the answer is further government regulation of the capitalists.  This “solution” would be very harmful because it is not based upon an accurate understanding of the situation.  America actually has a national socialist (or fascist) medical system where certain politically favored entities are given a monopoly over the medical market and allowed to defeat their competitors through regulations and licensing.  Any national socialist system can be recognized by its philosophy of private profits and public losses.

If America has a fascist medical system, how did it come into existence?  Americans love to call their country “the land of the free and the home of the brave.”  They take pride in defeating the Nazis during the Second World War and the Soviets during the Cold War.  The American people would never vote in a government which proclaimed its desire to institute totalitarian rule or to make the United States a communist nation.  The truth is that the current medical system came into existence through subterfuge and deception.  Although there have been many steps along the road from free market medicine to government managed health care, the most important increment was the publishing of the Flexner Report in 1910.  The first I heard of the Flexner Report was a passing remark in Health2O by Dr. Alexa Fleckenstein.  I have done some internet research and turned up surprising little information about the report; however, the reports effect on America’s health system is undeniable.

During the 1800’s, America had a relatively free market medical system with the two main competing schools of being homeopathic medicine and scientific medicine.  The scientific doctors were represented by the American Medical Association (AMA) and resented their competitors who drove down the cost of medical care and drew away customers.  The scientific doctors were probably also losing market share due to their use of harmful practices such as blood letting which used until the end of the 1800s.  Unfortunately the AMA was unwilling or unable to beat its competitors by offering either higher quality care or lower prices, so it called upon the strong arm of government force to vanquish them from the field.  Because of the AMA’s influence the government started regulating medical schools towards the end of the 19th century.

At this point the plot thickens.  The AMA began to carry out a plan to force schools with competing medical ideologies to shut their doors.  With the educational and licensing system under its control, the AMA would be able to prevent competing schools of thought from educating new practitioners or legally selling their services.  The potential medical cartel would artificially decrease the number of doctors and increase the salaries of those lucky enough to win its favor.

The AMA created the Council on Medical Education (CME) in 1904.  Through its rating system it managed to reduce the number of medical schools in the United States from 166 to 131 by 1910.  Additionally the Rockefeller Institute for Medical Research (RIMR) was founded in 1901 to conduct basic scientific research and its board was filled with politically minded people.  Simon Flexner head of the RIMR and the CME decided to commission a report calling for the standardization of medical education.  In order to cover their tracks it was decided to have the Carnegie Foundation hire Flexner’s brother Abraham (who had just written a book entitled The American College critical of America’s college system) to conduct the study. CME minutes show that Henry S. Pritchett president of the Carnegie Foundation agreed to keep his collaboration with the CME secret.

Surprisingly enough Flexner’s report concluded that there were too many doctors and medical schools in America and recommended reducing the number of schools.  The public outcry generated by the report convinced congress to declare the AMA the only body with the right to grant medical school licenses in the United States.  Flexner’s recommendation was to reduce the number of schools to 31, but fortunately the AMA controlled state medical boards only succeeded in shrinking the American medial educational system to 66 schools.  The AMA ordered the remaining schools to admit fewer students helping to make up for their leniency.  During this period four of the six medical schools for blacks in the US were closed.  Medical schools were also forced into closure by the Carnegie and Rockefeller foundations through the direction of funding towards schools sharing their views.  Today nearly half of all medical faculty members receive funding from the Carnegie and Rockefeller institutions.  Medicine not founded upon abstract scientific principles was driven from the scene: its schools were shuttered and its doctors were refused licensure.

Bringing about this artificial shortage of doctors through medical regulation caused several changes in the medical community.  Women, blacks, and the poor were driven out of the profession.  These groups were unable to spend the time and money necessary to complete an undergraduate degree as well as the four year medical education.  While this in and of itself was evil, it does not encompass the enormity of the crime.  The populations excluded from medical schools were often unable to obtain any medical care.  Due to the smaller number of practicing doctors poor people, blacks and those in rural areas were often unable to obtain any medical care at all.  During this period medical insurance was also monopolized by Blue Cross/Blue Shield which was dominated by the AMA.  This monopoly was obtained with the help of government money and privilege and is part of the reason why medical insurance costs so much today.

Even today the medical community sees the Flexner report high point and acknowledges that it is the basis of modern medical education.  Scientific doctors write in articles lauding how Abraham Flexner analyzed of all existing medical schools in ignorance of or neglecting to mention the cursory nature of Flexner’s examinations.  The fact that he visited some schools for barely a day including one stretch where he reviewed 69 schools in 90 days is not mentioned.  Estimates range but Flexner could only have spent an average of between 1.1 to 1.8 days at each school he visited over his 16 months investigation because of the speed of travel at that time.  The medical establishment has not set down Flexner’s torch as it continues its witch hunt against alternative medicine trying to ban it through regulation.  Despite the best efforts of the medical industrial complex, the public is now more favorable to and increasingly using alterative medicine after suffering through a century of fascist health care.

Bibliography

  1. Beaman, R.T., “The Health Care Mess:  The Flexner Report.”  [Online] 14 December 2008.” http://www.libertyforall.net/?p=1613.
  2. Bowman, R.C. “Flexner’s Impact on American Medicine.” [Online] 14 December 2008.  http://www.unmc.edu/Community/ruralmeded/flexner.htm.
  3. Cooke, M., David, I.M., Sullivan, W., Ludmerer, K.M., “American Medical Education 100 Years afer the Flexner Report.” [Online] 26 November 2008.  http://content.nejm.org/cgi/content/full/355/13/1339
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  9. Rockwell, L.H., “The Trouble With Licensure.” [Online] 14 December 2008. http://www.lewrockwell.com/archives/fm/08-90.html.
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