Americans looking to improve their health-care system - and wondering about the implications of more government involvement - can find valuable lessons in Philadelphia's recent past. In the decades following World War II, Philadelphia had a successful public hospital that enjoyed widespread public support and an excellent national reputation.
Philadelphia General Hospital was affectionately known as "Old Blockley," having succeeded the Blockley Almshouse in what was once Blockley Township, now University City. It served city employees and patients who were indigent or could not get care elsewhere.
During the 1950s, the hospital thrived as Mayors Joseph S. Clark and Richardson Dilworth invested substantial resources in its operations. Top medical residents and nursing students coveted positions there because it employed highly respected doctors and provided a first-rate education. Philadelphians felt great affection for the hospital because it provided essential services and its success reflected well on the entire city.
In the late 1960s and early '70s, Old Blockley deteriorated due to chronic underfunding. Yet when Mayor Frank Rizzo announced plans to close it, a broad coalition of doctors, nurses, labor unions, health-care activists, welfare recipients, and patients (many in wheelchairs) took to the streets and marched to City Hall, waving signs. Fewer than one in six Philadelphians polled in 1976 supported the closing, which eventually took place the following year.
Philadelphia General Hospital embraced two core principles that laid the foundation for a just, efficient health-care system: that everyone deserves health care, and that no one should be looked down upon for his or her medical conditions or financial circumstances. The hospital's policies required the staff to treat even the poorest patients not as charity cases, but as citizens who should receive the best care available. Doctors and nurses prided themselves on affording all patients such respect, addressing each of them, no matter how downtrodden, as "Mr." or "Mrs."
The hospital's policies led many patients who felt alienated by other institutions to actively pursue care there, often taking buses across the city to get to it. Although private hospitals would provide care for poor and uninsured patients, many of them refused to treat those with chronic or stigmatized conditions. By contrast, Old Blockley accepted everyone, regardless of illness or ability to pay, fostering a sense that all people deserved health care.
African Americans felt a particularly strong attachment to the hospital. Many distrusted white health-care institutions, which had a history of refusing to hire black doctors and nurses and of treating black patients as second-class citizens. In the postwar years, an increasing number of African Americans sought care at the public hospital. Three-quarters of the hospital's predominantly African American patients told interviewers in the late 1960s that even if they had enough money to get health care anywhere, they would still choose Old Blockley - an extraordinary testament to the trust and loyalty the hospital cultivated.
Today's poor and uninsured often do not get adequate preventive care because they cannot pay for it. They distrust medical institutions, causing minor problems to become severe conditions that are often expensive to treat. But Philadelphia General Hospital's core principles helped encourage the dissemination of preventive care, which is a cornerstone of a fiscally sound universal health-care system.
By building lifelong partnerships with patients, Old Blockley encouraged even the most socially marginalized Philadelphians to seek treatment. Many patients expressed a deep trust of the hospital, reporting that it was a "tradition" in their families and that they encouraged their friends and relatives to go there.
At a time when our nation faces hard choices about the kind of health care we want, this is an important example of government-funded health care that worked. It's also a reminder that the public has historically supported government expenditures on high-quality, effective treatment provided as an entitlement for all.
This is not just a moral principle, but a practical one. Costs are best controlled not by denying expensive treatments, but by creating a welcoming environment for all patients and encouraging them to seek affordable, preventive care. Let these be the lessons of Old Blockley.