Robert Herrick’s novel The Web of Life (1900), a self-proclaimed work of literary realism, opens a critical window onto an urban “web” of intersecting practices, institutions, and professional formations at a moment when key dimensions of the US health-care system as we know it today were first taking shape. At this fluid historical moment, Herrick stages a competition between two contrasting possibilities for what that system would, or should, look like in the new century. One possibility consists of a democratic profusion of health-care providers and options, all of which jostle against one another in a marketplace largely unregulated by any external authority. Herrick implicitly associates this energizing, though unsettling, model of US health care with both the labor movement (the novel is set in the same year as Chicago’s Pullman strike) and certain aspects of the New Woman movement. The second possibility the novel showcases, which is closer to the model that would historically prevail, envisions a health-care system that is centralized, rationalized, and directed from the top down by the so-called orthodox profession. Herrick aligns this model with powerful banks, trusts, and corporations. The book presents the competition between these alternative paradigms by following the shifting career choices and internal conflicts of its protagonist, Dr. Howard Sommers, as he strives to satisfy his own vision—at times itself contradictory—of medical professionalism. By the end of the novel, both Sommers and The Web of Life have been forced to acknowledge if not the desirability, then the practical necessity, of the orthodox profession’s monopoly on health care. This reluctant endorsement on Herrick’s part also offers an important perspective on why large-scale systemic reform in US health care has proven so difficult to achieve in the more than a century that has passed since the novel was written.

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