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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Average Customer Rating: 5.0 out of 5
Description:
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.
Publisher: Basic Books
Customer Review: 5 out of 5
Slightly dated, but as prize-worthy now as it was then, and still quite relevant. - This book should have been required reading of politicians and talking-heads engaged in the health care reform debate a few months ago. The Social Transformation of American Medicine has aged only a bit. The last chapter is out of date, but its predictions are somewhat chilling--that doctors have more to fear from the corporate takeover of medicine than putative reform.
Starr takes a long historical view of the medical profession and the role of doctors in it, paying attention to ancillary issues like hospitals, public health policies, among others. Starr's book should shake loose a lot of commonly held chestnuts about medicine in the US, most prevalently that doctors always enjoyed unprecedented social status or that doctors used to operate in a free-market atmosphere. As the title suggests, Starr points out that medicine and medical care has transformed from being home-based to being, more or less, "industrial" (albeit controlled but what might be considered a cartel). Key to this transformation is the sovereignty accorded this profession, often at the expense of health care's accessibility, not to mention cost.
Starr is not afraid to mince words or leave inferences unstated. In particular (as stated before) that doctors always operated in a free market free from government regulation (indeed, regulation is one of the ways doctors "captured" medical care, that government intervention/investment had nothing to do with the reputation the US enjoys in experimental medicine or research, that health care "crises" have long roots in American history, and that the role of corporations in present-day medical care has again transformed American medicine (and will continue to do so. Part history, part sociology, and part public policy analysis, this book provides much useful info in judging the heal care debate.
Customer Review: 5 out of 5
good job - delivered in the condition advertised, on time. The book is a treatise on the state of the American medical system (In 1984), and how it got there.
Customer Review: 5 out of 5
A relevant history of medical care systems - This outstanding history of the system, or lack of it, of health care delivery in the USA is exceptionally relevant now, 2009, during the health care debates. It's a long, detailed book, but it's objective and well-referenced. Although this reflects history up to 1980, many of the forces set in motion during the period covered continue to this day. Some details are fascinating, e.g., the author believed that the best opportunity for national health care came in 1974, in motions proposed by Ted Kennedy but likely to be credited to Nixon who was then enduring the revelations of Watergate. That scandal and the opprobium then attached to Nixon probably can be blamed for the death of that attempt.
Customer Review: 5 out of 5
A Physician's Must - I came across this book first as part of my academic studies and initially felt it to be purely historical with no basis for current public health implications. But, if you read the text fully and deliberate on the issues present the information presented give you an accurate view of how the current geo-political atmosphere in US healthcare has been shaped to this day. The reader can see how many transformations have taken place. Namely, medicine as an artistic medium not highly regarded to one that is the primodial center of scientific acheivement. Another example is hospitals as refuges for storing the deceased to now institutions of recovery and training for young physicians. Starr divides this book into 2 parts - the rise of sovereign profession and the struggle for medical care. In invidual chapters he highlights the key historical events and intermixes this with insightful commentary where practical implications can be drawn in regards to the profession as it stands today. As a healthcare practitioner who has worked anywhere from managed care to community health centers to the private sector, I feel this book has helped me realize largely why the system is the way it is. I would recommend this to any aspiring healthcare leader who wishes to be effective in his/her organization.
Customer Review: 5 out of 5
The best history of medical economics we have. - I've read this book at least four times. I relied on it for A Brief History of Disease, Science and Medicine, my own book's chapter on medical economics. It ends before the period of for-profit HMOs, a pernicious influence, but it does explain how we got into this dilemma. Anyone who wants to understand the American health care system should read Starr's book. Then, if they want to see an alternative, read Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France (The Culture and Politics of Health Care Work) the history of the evolution of the French system, which is the best European health program and which shares many features with our own. It is interesting to see why we never got to coverage of the entire population and gives a hint about how we could get there. Canada is definitely not the model for us; France might be.
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