In 334 B.C., Alexander the Great, having triumphed in Macedonia and Greece, visited Troy en route to his Asian campaign. Although we know he visited the tomb of Achilles (whom he had admired, like no other, since reading Homer as a child) with his trusted general and friend, Hephaestion, there is no significant recorded detail about his time there. However, knowing what we do about Alexander and his sense of predestination, it might well have gone something like this:

Alexander purposefully strode into the ruins of Achilles tomb, then suddenly stopped. He slowly turned his head from side to side, and then upward examining the eroding columns surrounding him, most no longer supporting any structures above. He then looked down at the rubble that the fallen stone lintels had become.

Strange, he uttered under his breath, then spoke audibly, strange this impermanence. It matters not what ones exploits, or what civilizations one might conquer. This was Achilles, the greatest warrior the world has ever known before now.

He looked up and over at Hephaestion, then back at one of the pillars, running his hand over the once polished, but now uneven and pitted surface one always has the sense that his physical form is impermanent, but it is obvious that the monuments erected in his favor, no matter how grand, or how sound are no different all goes to dust in time.

He patted one of two pillars still intact and sharing a supported structure above. He looked up again and smiled, my master Aristotle was a great admirer of trabeation this post and lintel form it was for millennia the strongest known structure, prior to the arch.

His brow then furrowed, and his countenance darkened. He leaned forward, placing his forehead onto his hand resting upon the stone, and no longer smiling, he whispered, you too; however, will fall.

Sure, I could have just said, nothing lasts forever, but it just seemed more powerful and dramatic to put the words into the mouth of someone who once conquered the world

Paul Starr, professor ofsociologyandpublic affairsatPrinceton University, and co-Editor of The American Prospect, wrote the book The Social Transformation of American Medicinein 1984 one that deservedly won the Pulitzer Prize for General Non-Fiction that year.

Starr described in great detail the pathway that the enterprise of health care had taken from the early nineteenth century up to that time from an informal home- and community-based undertaking, to a huge and powerful industry. Although written more than a quarter of a century ago, revisiting Starrs framework is helpful when one considers the massive sociologic change that is in process at this moment, and one that will change the health care delivery system like nothing that has come before even when one weighs against it things such as the accumulated mass of biomedical scientific discovery.

Starr suggests that the medical-industrial enterprise has been built, on another trabeative (pillar and lintel) structure. Consider two solid columns, holding up a large monolithic rectangular stone. One column represents Dependence, and the other, Legitimacy. The large lintel stone on top is Authority.

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Health Care's New Social and Structural Transformation