elf-employed professional. Britain had a limited national health insurance from as early as 1911, but like Medicare in the United States it represented only a modest intrusion in an otherwise free-market system (Willcocks, pp. 20-21). In British novels with a prewar setting, such as Agatha Christie's The Murder of Roger Ackroyd, doctors appear with much the same social and economic status as their American counterparts, with a standing comparable to lawyers and local business people. Where doctors were grouped in a practice, their self-employed status was not significantly compromised; two or three doctors might share an office and receptionist, but their practices remained otherwise independent. The economics of medicine in both countries was, typically and normatively, straightforward "fee for service," with little or no third-party participation. If you went to the doctor, he (almost invariably a he) billed you directly, you paid, and that was the end of it. Health insurance in any form was as much an exception as institutional medicine.
All of this was in the context of a health-care sector that by modern standards was very small as a component of the economy, and very limited in its capabilities. Until the development of penicillin, the ability of medicine to cure diseases was by modern standards nearly nonexistent. Doctors could treat injuries, though their prospects with severe injuries were limited, and provide anticeptic conditions and limited intervention for events such as childbirth. They could perform some operations, such as appendectomies. They could prescribe treatments to alleviate the misery of illness and increase the prospects of recovery. And they could offer prognoses, determining whether a condition was treatable, and advising as to its probable course and effects.
These, however, were more or less the limits of medical practice (Ayres, pp. 8-15). The occasions for seeking medical care were thus...