The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry

The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry

by Paul Starr


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Considered the definitive history of the American healthcare system, The Social Transformation of American Medicine examines how the roles of doctors, hospitals, health plans, and government programs have evolved over the last two and a half centuries. How did the financially insecure medical profession of the nineteenth century become a most prosperous one in the twentieth century? Why was national health insurance blocked? And why are corporate institutions taking over our medical care system today? Beginning in 1760 and coming up to the present day, renowned sociologist Paul Starr traces the decline of professional sovereignty in medicine, the political struggles over healthcare, and the rise of a corporate system.

Updated with a new preface and an epilogue analyzing developments since the early 1980s, this new edition of The Social Transformation of American Medicine is a must-read for anyone concerned about the future of our fraught healthcare system.

Product Details

ISBN-13: 9780465093021
Publisher: Basic Books
Publication date: 05/30/2017
Edition description: Updated
Pages: 592
Sales rank: 157,221
Product dimensions: 5.90(w) x 9.10(h) x 1.70(d)

About the Author

Paul Starr is a professor of sociology and public affairs at Princeton University and holds the Stuart Chair in Communications and Public Affairs at the Woodrow Wilson School of Public Affairs. A multiple prize-winning author of several books and the cofounder and coeditor of The American Prospect, Starr lives in Princeton, New Jersey.

Table of Contents

Book 1A Sovereign Profession: The Rise of Medical Authority and the Shaping of the Medical System
Introduction: The Social Origins of Professional Sovereignty3
The Roots of Authority
Dependence and Legitimacy
Cultural Authority and Occupational Control
Steps in a Transformation
The Growth of Medical Authority
From Authority to Economic Power
Strategic Position and the Defense of Autonomy
Chapter 1Medicine in a Democratic Culture, 1760-185030
Domestic Medicine
Professional Medicine
From England to America
Professional Education on an Open Market
The Frustration of Professionalism
The Medical Counterculture
Popular Medicine
The Thomsonians and the Frustration of Anti-Professionalism
The Eclipse of Legitimate Complexity
Chapter 2The Expansion of the Market60
The Emerging Market Before the Civil War
The Changing Ecology of Medical Practice
The Local Transportation Revolution
Work, Time, and the Segregation of Disorder
The Market and Professional Autonomy
Chapter 3The Consolidation of Professional Authority, 1850-193079
Physicians and Social Structure in Mid-Nineteenth-Century America
Medicine's Civil War and Reconstruction
The Origins of Medical Sectarianism
Conflict and Convergence
Licensing and Organization
Medical Education and the Restoration of Occupational Control
Reform from Above
Consolidating the System
The Aftermath of Reform
The Retreat of Private Judgment
Authority over Medication
Ambiguity and Competence
The Renewal of Legitimate Complexity
Chapter 4The Reconstitution of the Hospital145
The Inner Transformation
Hospitals Before and After 1870
The Making of the Modern Hospital
The Triumph of the Professional Community
The Pattern of the Hospital System
Class, Politics, and Ethnicity
The Peculiar Bureaucracy
Chapter 5The Boundaries of Public Health180
Public Health, Private Practice
The Dispensary and the Limits of Charity
Health Departments and the Limits of Government
From Reform to the Checkup
The Modernization of Dirt and the New Public Health
The Prevention of Health Centers
Chapter 6Escape from the Corporation, 1900-1930198
Professional Resistance to Corporate Control
Company Doctors and Medical Companies
Consumers' Clubs
The Origins and Limits of Private Group Practice
Capitalism and the Doctors
Why No Corporate Enterprise in Medical Care?
Professionalism and the Division of Labor
The Economic Structure of American Medicine
Book 2The Struggle for Medical Care: Doctors, the State, and the Coming of the Corporation
Chapter 1The Mirage of Reform235
A Comparative Perspective
The Origins of Social Insurance
Why America Lagged
Grand Illusions, 1915-1920
The Democratization of Efficiency
Labor and Capital Versus Reform
Defeat Comes to the Progressives
Evolution in Defeat, 1920-1932
The New Deal and Health Insurance, 1932-1943
The Making of Social Security
The Depression, Welfare Medicine, and the Doctors
A Second Wind
Symbolic Politics, 1943-1950
Socialized Medicine and the Cold War
Three Times Denied
Chapter 2The Triumph of Accommodation290
The Birth of the Blues, 1929-1945
The Emergence of Blue Cross
Holding the Line
The Physicians' Shield
The Rise of Private Social Security, 1945-1959
Enter the Unions
A Struggle for Control
The Growth of Prepaid Group Practice
The Commercial Edge
The Accommodation of Insurance
Chapter 3The Liberal Years335
Aid and Autonomy, 1945-1960
Public Investment in Science
The Tilt Toward the Hospital
The Structural Impact of Postwar Policy
The New Structure of Opportunity
The New Structure of Power
Redistribution without Reorganization, 1961-1969
The Liberal Opportunity
Redistributive Reform and Its Impact
The Politics of Accommodation
Chapter 4End of a Mandate379
Losing Legitimacy, 1970-1974
Discovery of a Crisis
The Contradictions of Accommodation
The Generalization of Rights
The Conservative Assimilation of Reform
Health Policy in a Blocked Society, 1975-1980
An Obstructed Path
The Generalization of Doubt
The Liberal Impasse
The Reprivatization of the Public Household
Chapter 5The Coming of the Corporation420
Zero-Sum Medical Practice
The Doctor "Surplus" and Competition
Collision Course
The Growth of Corporate Medicine
Elements of the Corporate Transformation
The Consolidation of the Hospital System
The Decomposition of Voluntarism
The Trajectory of Organization
Doctors, Corporations, and the State

What People are Saying About This

H. Jack Geiger

"The definitive social history of the medical profession in America....A monumental achievement."

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Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry 4.5 out of 5 based on 0 ratings. 2 reviews.
Anonymous More than 1 year ago
Clearly demonstrates the growth of the healthcare system and its stakeholders and the complexities in impacting it and making positive change. A must read for anyone in healthcare and those trying to change it for the better.
smudgedlens on LibraryThing More than 1 year ago
How medicine fell from being a humanitarian profession to an entreprenurial enterprise.