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

by Paul Starr

Overview

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

	Preface	ix
	Acknowledgments	xiii
Book 1	A Sovereign Profession: The Rise of Medical Authority and the Shaping of the Medical System
	Introduction: The Social Origins of Professional Sovereignty	3
	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 1	Medicine in a Democratic Culture, 1760-1850	30
	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 2	The Expansion of the Market	60
	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 3	The Consolidation of Professional Authority, 1850-1930	79
	Physicians and Social Structure in Mid-Nineteenth-Century America
	Class
	Status
	Powerlessness
	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 4	The Reconstitution of the Hospital	145
	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 5	The Boundaries of Public Health	180
	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 6	Escape from the Corporation, 1900-1930	198
	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 2	The Struggle for Medical Care: Doctors, the State, and the Coming of the Corporation
Chapter 1	The Mirage of Reform	235
	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 2	The Triumph of Accommodation	290
	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 3	The Liberal Years	335
	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 4	End of a Mandate	379
	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 5	The Coming of the Corporation	420
	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
	Notes	450
	Index	496

What People are Saying About This

H. Jack Geiger

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

Editorial Reviews

"The definitive social history of the medical profession in America....A monumental achievement."—New York Times Book Review

"Superb sociology, superior history—and essential reading for anyone interested in the fate of American medicine."—Newsweek

"The most ambitious and important analysis of American medicine to appear in over a decade.... If you read only one book about American medicine, this is the one you should read."—Ronald Numbers, author of The Creationists: The Evolution of Scientific Creationism

From the Publisher

....This important book is written with wit, irony and great style. --The New York Times Books of the Century

Charles McGrath

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