Social medicine vs professional dominance: the German experience.

This article describes the efforts by German workers' groups and pioneering social physicians to design health care services oriented to prevention and cost-effective treatment. Jews played a key role in developing these prototypes of today's health maintenance organizations (HMOs) and preferred provider organizations (PPOs). The growing success of these services threatened private practitioners in a number of ways. They formed a trade union and took militant action. Stage by stage, the profession asserted its dominance, culminating in an alliance with the National Socialists and Hitler to take over these services and to purge them of socialist and Jewish physicians. Medical societies assisted Hitler in his policies of "purification," and the health care delivery systems shifted from being local, patient-centered, and health-oriented to being national, physician-centered, and focused on curing illness. After World War II, these changes were not reversed as part of denazification, and 40 years later, social medicine has yet to recover.