CONTEMPORARY notions about the organization of medical care in the United States seem to consist of bizarre mixtures of compassion, urgency, and irrationality, apparently uninfluenced by experiences in other countries. At the heart of the matter appear to be a series of ideas unique in the annals of medical care.
One group of ideas can be characterized as embracing the categorical approach to the provision of personal health services. For example, it is proposed that personal health services be organized by disease categories, such as those for patients with heart disease, stroke, and cancer; by age group categories, such as the programs for "children and youth" or the "over 65"; or by geographic categories, such as neighborhood health centers in the ghettos and multicounty health department clinics in Appalachia. It is assumed that the categorical approach to payment for medical care, social insurance for the aged, and social welfare for