Good health care is essential, and Americans watch closely as President Obama and Congress struggle to determine how to deliver basic medical service to all Americans.

It helps to put the problem of health care in perspective. Consider the medical situation in the United States in the early twentieth century. Then the nation had a large number of medical colleges (166 in 1904), and they turned out twice as many graduates as were required to meet the people’s needs. In proportion to population, the United States had twice as many physicians as England, four times as many as France, five times as many as Germany, and six times as many as Italy. Most of these schools were owned by doctors, who operated them for a profit. Standards were low and laboratory instruction was minimal. The nation had too many medical schools, too many physicians, and a great oversupply of poor or mediocre practitioners. Before the advent of university-based medical education, Chicago had an abundance of medical schools, but with regard to medical education it was aptly called “the plague sport of the nation.”

The reform of medical education that gathered momentum in the early twentieth century gradually transformed the quality of health care in America. Today medical education in the United States is based in universities, and the nation is widely recognized as a world center of medical research and education.

Yet, the problem of delivering quality health care to all the American people remains.

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Winton U. Solberg is professor emeritus of history at the University of Illinois at Urbana-Champaign and author of the new book Reforming Medical Education: The University of Illinois College of Medicine, 1880-1920.