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

Paul Starr

Language: English

Pages: 528

ISBN: 0465079350

Format: PDF / Kindle (mobi) / ePub

Winner of the 1983 Pulitzer Prize and the Bancroft Prize in American History, this is a landmark history of how the entire American health care system of doctors, hospitals, health plans, and government programs has evolved over the last two centuries.

"The definitive social history of the medical profession in America....A monumental achievement."—H. Jack Geiger, M.D., New York Times Book Review

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continuing conflict in American life between the democratic respect for common sense and professional claims of special knowledge. DOMESTIC MEDICINE The family, as the center of social and economic life in early American society, was the natural locus of most care of the sick. Women were expected to deal with illness in the home and to keep a stock of remedies on hand; in the fall, they put away medicinal herbs as they stored preserves. Care of the sick was part of the domestic economy for which

part, nor a pose of neutrality. I have written elsewhere on more immediate questions of policy, and it will scarcely require a cryptographer to decipher my sentiments, especially in some of the final chapters. But history does not provide any answers about what should be done. Were I to take up problems of political choice, it would require me to speak here in a diflFerent voice and, indeed, to write another book. My hope is that this historical analysis may help to illuminate our present

physicians in the United States rose from five to forty thousand, a rate of growth faster than that of the population. As a result, the number of people per doctor dropped from about 950 to 600 during the same period.14 Doctors complained continually about overcrowding in the profession. As a result of unrestricted entry into practice, doctors were apparently well distributed through rural areas. "Physicians, even in surplus quantity, were available to the most remote New England towns, but the

aftermath of the expulsion of the Massachusetts homeopaths, The New York Times commented that while the medical society "meant to disgrace the heretical physicians . . . we have little doubt that in the minds of all intelligent persons they have only succeeded in bringing disgrace upon themselves."59 Many saw diversity in medical practice as a counterpart to religious differences. When the orthodox sought control of medical practice, they bridled: One could no more have boards of orthodox doctors

Contents vii CHAPTER SIX 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 T W O T H E STRUGGLE FOR M E D I C A L CARE Doctors, the State, and the Coming of the Corporation CHAPTER ONE The

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