The Social Transformation of American Medicine

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"With a new epilogue by the author"--Cover.
Originally published by Basic Books in 1982.
Book one. A sovereign profession: the rise of medical authority and the shaping of the medical system -- Introduction: The social origins of professional sovereignty -- The roots of authority: Dependence and legitimacy ; Cultural authority and occupational control -- Steps in transformation: The growth of medical authority ; From authority to economic power ; Strategic position and the defense of autonomy -- Chapter one. Medicine in a democratic culture, 1760-1850 -- 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 two. The expansion of the market -- 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 three. The consolidation of professional authority, 1850-1930 -- 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 four. The reconstitution of the hospital -- 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 five. The boundaries of public health -- 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 six. Escape from the corporation, 1900-1930 -- 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 two. The struggle for medical care: doctors, the state and the coming of the corporation -- Chapter one. The mirage of reform -- 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 two. The triumph of accommodation -- The birth of the blues, 1929-1945: The emergence of the 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 three. The liberal years -- 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 four. End of a mandate -- 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 five. The coming of the corporation -- 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 -- Epilogue. Chain reactions, 1982-2016 -- Cycle 1: The rise and retreat of managed care, 1982-2000: The revolt of the payers ; The ordeal of reform in the 1990s ; Turning toward monopoly I -- Cycle 2: Market fantasies and market power, 2001-2016: Putting consumers at risk ; The ordeal of reform in the 2000s ; Turning toward monopoly II -- Medical care in a new environment: Corporate bound? ; The elusive promise of innovation.
"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."-- Amazon.com.
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. --! From back cover.

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