Although sexually transmitted diseases, tuberculosis and other infectious illnesses by no means disappeared and continued to disproportionately afflict the nation's poor, many in the middle and upper classes believed mankind's age-old struggle against contagion had ended in triumph. In 1969, the U.S. surgeon general told Congress as much, concluding that the nation could "close the books on infectious diseases."
No longer frightened by contagion, middle-class Americans increasingly saw health as a private matter, looking to high-tech medicine for the next great advances. Federal spending on medical research surged as state and local public-health spending ebbed.
As the perceived need for robust public-health measures diminished, concern about violation of personal autonomy in the health sphere soared. Revelations of Nazi medical atrocities and reports that American clinical researchers exposed unknowing people to radiation and other life-endangering hazards inspired a large shift in medical ethics, toward patient autonomy as the central principle. The civil rights revolution of the 1960s and 1970s quickened this transformation.
Then came the AIDS epidemic in the 1980s and 1990s. AIDS activists battled successfully for public-policy responses that intruded minimally on personal autonomy and privacy. The AIDS paradigm for coping with a public health crisis treated government as more of a threat than a solution. This civil-libertarian response to AIDS was of a piece with the individualism and the cult of the entrepreneur that have flourished in American culture for the past 20 years.