After a few months, his legs started to hurt. He went to a hospital but couldn’t afford all the tests necessary for a full diagnosis. He left Beijing and went back to his family, but rural hospitals rarely have specialist care; many can’t afford basic equipment. In September, 2010, Li and his grandfather booked cheap tickets on the ten-hour night train to Harbin, the nearest major city.

Like all top-tier hospitals in China, the one in Harbin was thronged. A doctor diagnosed synovitis, an inflammation of the joint lining, and prescribed a series of shots for Li. This turned out to be a misdiagnosis, and at the trial Wei argued that treatment for the wrong disease worsened Li’s condition.

By the following spring, it was evident that the medicine wasn’t working. Li, still in his mid-teens, walked like an old man. “He couldn’t even squat when he went to the bathroom,” his grandmother told reporters later. In April, his grandfather took him back to Harbin. This time, the diagnosis was the correct one: ankylosing spondylitis, a chronic inflammatory disease that can result in a complete fusion of the vertebrae known as “bamboo spine.”

The condition is incurable, but doctors explained that the symptoms could be treated with an intravenous drug called Remicade. For a poor Chinese family, the cost was daunting—thirty-nine thousand yuan (more than six thousand dollars) for the course of injections. As a migrant worker, Li had some insurance, but the plan covered less than half of the total cost, which eventually came to around eighty thousand yuan. The remainder he and his family had to pay out of pocket. They scraped together the funds using Li’s welfare subsidies and his grandfather’s pension, and borrowing the rest from family and friends.

After the first round of Remicade injections, Li immediately felt better. He trotted around the family’s courtyard, yelling to his grandmother, “Look, I can run!” But a month later doctors found that he had tuberculosis—a likely consequence of the drug’s tendency to weaken the immune system. They’d have to halt the Remicade, they told him, until the t.b. was cured. In his defense brief, Wei argued that the hospital had detected tuberculosis before giving Li the injections, inviting the suggestion that it hadn’t said anything because the medication is so lucrative.

Before he could continue with his back treatment, Li had to spend four months in a hospital in Hulunbuir, taking an anti-tuberculosis drug. According to his grandfather, during this period Li started to act strangely. He would suddenly burst out laughing, and walk around at night shouting. Still, by the time the pair returned to Harbin for the last time, they were feeling optimistic. News that the t.b. still hadn’t receded completely and that Remicade treatment would have to be delayed for three more months was crushing. The doctor didn’t tell Li the bad news directly; instead, he made him stand outside his office while he talked to Li’s grandfather. According to Wei, it was at this moment that his client felt most insulted. “Li’s mind-set was now ‘Are the doctors tricking me?’ ” he told me. “All he knows is he’s been there many times, and each time it’s ‘No, no, no.’ ”

One of China’s first doctors was Bian Que, a semi-mythical figure of the fifth century B.C., remembered for his ability to see through the human body and to raise the dead. But he seems to have been underappreciated in his own time: when he told the king of Qi that he looked sick, the king dismissed him, suspecting that the doctor was trying to cheat him out of his money. Days later, the king died. Hua Tuo, a famous surgeon in the second century A.D., recommended removing a tumor from the brain of a general, who, suspecting a murder plot, had him executed—an early instance of patient-on-doctor violence.

Despite China’s rich history of traditional medicine, professional practitioners haven’t always fared well. The Confucian system held that every gentleman should have enough medical knowledge to take care of his family himself, and even the best doctors had low rank. The Qing-dynasty medical scholar Xu Yanzuo was disdainful of the level of competence. “Rarely do people die of diseases,” he wrote. “They often die from medicine.”

Modern medical techniques, which evolved in Europe and North America in the nineteenth century, were slower to take hold in China. Well into the twentieth century, doctors continued to practice a mixture of traditional healing and modern medicine, and it wasn’t until the Communist takeover, in 1949, that the Chinese government assumed any responsibility for health care. Vaccination drives, improved sanitation, and a campaign to eradicate the “four pests”—rats, flies, mosquitoes, and sparrows—curbed disease and reduced child mortality. In 1965, on the brink of the Cultural Revolution, the Party announced an initiative to provide every production brigade with “trained medical personnel who are practitioners part time and do physical work.” These “barefoot doctors,” as they became known, were typically peasants, along with a few urban youths. By Western standards, they were amateurs, but the system at least provided rural Chinese with access to very basic treatment. Ten years after the start of the program, life expectancy in China had increased from fifty-one to sixty-five years.

Some barefoot doctors went on to have significant careers in medicine. One is Gordon Liu, whom I met at his office at Peking University, where he is the director of the China Center for Health Economics Research. His office is in a resplendent Qing-dynasty building, overlooking a courtyard on one side and a river on the other. “I got the best spot,” he said, with a grin. Liu, who has spent most of his career in the United States, was wearing Nike sweatpants and a casual Boss shirt. He spoke with the offhand confidence of a professor in permanent lecture mode. Whenever I asked a question, he’d pause and say “O.K.” before starting again, as if I’d interrupted his flow.

Liu grew up in rural Sichuan, and, like most young people during the Cultural Revolution, was sent to work on a collective farm as soon as he finished high school. He remembers waking up at 6 A.M. to plant corn in soil that wasn’t suitable for corn. “Every day, we had to do that kind of meaningless work,” he said. One day, the village leader called him in and told him that he would be the village doctor. His qualifications: he had a high-school diploma.

“I knew nothing about medicine,” Liu told me. “I just began to treat people. I don’t even know how many people got worse after my treatment, how many people died. I have no clue.” Still, barefoot doctors were respected and patients didn’t complain about the standard of care. “People were fighting for a cup of water, a bowl of rice,” Liu said. “Health care was not even on their agenda.”

After Mao died, in 1976, China reopened its universities, and Liu attended college in Chengdu. In 1986, he went to the City University of New York’s Graduate Center, to study health economics, and stayed on in the United States, teaching. China’s medical system, meanwhile, fell apart. Deng Xiaoping instituted a program of economic liberalization, which dismantled the system of co-operatives that many had relied on for medical care. While the hands-off approach boosted certain sectors of the economy, like manufacturing and real estate, it crippled the health system. The state was no longer responsible for providing health care, and public hospitals, in charge of their own financing, went after profits. Doctors were poorly paid and many of them started taking bribes, the money typically stuffed in a “red envelope.” Under the old system, teams of educated city doctors had travelled to rural areas to supplement the service of the barefoot doctors; now sick farmers had to come to the provincial capitals for the best treatment, and big urban hospitals became overburdened. “The government basically considered health care a back-burner issue,” Liu said.

By the beginning of this century, everyone from patients to doctors and government leaders agreed that the system was broken, and the SARS epidemic, which started in southern China in 2002, added to the sense of crisis. In 2003, the government created a medical-insurance system for people living in rural areas, and in 2007 it added a plan for urban residents. In 2002, Liu, who was teaching at the University of North Carolina Chapel Hill, got a call inviting him to Beijing to help establish the department of Health Economics and Management at Peking University. He accepted. “It was my dream,” he said.

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In Beijing, Liu began to advise the State Council, China’s top administrative body, which drafts legislation and generally decides the direction of national policy. In 2009, the council announced a reform package with five components: the government would get the entire population insured by 2020; it would bring down the cost of basic drugs; it would boost public-health services, like education and immunization, especially in the poorest regions; it would invest in hospitals in rural areas, to reduce the pressure on urban hospitals; and it would restructure big public hospitals so that they focussed on emergency care and specialist services. This last item has been the trickiest part, Liu said, because it entails taking customers away from the big hospitals. “Hospitals will never do that themselves, unless you surgically conduct the reform,” he said.