To commemorate the semi-centennial of the UK's national health service (NHS) in 1998, The Lancet published a full-page reproduction of Sir Luke Fildes' painting The Doctor under the heading “NHS at 50”. It seemed to capture a message that for more than a century has been attached to the image: here was a visual embodiment of the physician's devotion to patients, and, in this instance, the state's commitment to guarding the health of the people.

From the perspective of a historically informed American eye, however, the choice was staggeringly ironic. For The Doctor had a pivotal role in blocking the creation of a counterpart to the NHS in the USA. In the late 1940s and early 1950s, it was under a banner graced with this image that the American Medical Association (AMA) successfully led the battle against universal government health insurance. Widely circulated during the early Cold War, the image became a lightning rod for clashing conceptions of the medical profession as an American institution, the doctor-patient relationship, and the ways that access to health care should define the nation.

Fildes' painting was commissioned by Henry Tate and first exhibited in 1891 at the Royal Academy in London. In the USA engravings quickly appeared in doctors' waiting rooms; it was recreated in tableaux vivant, and, in 1911, was the subject of a film by Thomas Edison. At the 1933 Chicago World's Fair, Petrolagar Laboratories exhibited a life-size diorama of the scene, celebrating “the ideal relationship between physician and patient—‘The Human Touch’”; the exhibit then went on tour and was viewed by at least 5 million people. During the Depression, the painting appeared widely in popular media lamenting the passing of the family doctor.

Between 1943 and 1950, a series of national health insurance bills were debated in the US Congress. In 1947, The Doctor appeared on a postage stamp commemorating the AMA's centenary. And AMA activists went on to deploy the painting as emblematic of all that would be lost if the state were to impose what they called “socialised” medicine, and, in the same breath, “fascist” health care. The Doctor appeared in pamphlets, print advertisements, and, at medical conventions, on gigantic banners, all with the slogan, “Keep politics out of this picture”.