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on October 1, 1998
Since this book was written in 1985, I have used it to teach medical students about the changes in American healthcare. The last chapter, "The Coming of the Corporation," forecasts what has happened in the last decade. This book is a must for all who want to understand why the changes are occurring in American healthcare
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on May 3, 2003
This Pulitzer Prize winning history of American Medicine does a lot to explain why the domain of public health is so small in the U.S., and why health in the U.S. is mostly a private, as opposed to public, matter. It takes some fortitude to get through, but it should be required reading for anyone who has ever wondered why, for better and for worse, the US is the only developed country that does not have social provision of medical care. Hint: It's not an accident. Recommended
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on January 8, 2004
For anyone interested in the healthcare as a profession or area of study, I can't recommend this book highly enough. Despite the 20 years since its publication, Paul Starr's Pulitzer prize winner is still relevant today and in retrospect his projections made of the future of healthcare in America are surpisingly prescient.
The first book describes the development of the medical profession in early America providing a fascinating look at the social evolution of American society. The second book delineates the rise of doctors, hospitals and medical schools in latter half of the 19th to the early 20th century with the rise of science and a professional authority. The third book shifts the focus from the doctors and to the industry that medicine became as well as the various attempts at healthcare reform in response to rising healthcare costs.
My only criticism is that Starr should have devoted more pages to the root causes behind the rising healthcare costs that drove the reforms of the 1960-70s described in the third book.
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VINE VOICEon December 27, 2006
The evolution of American medicine is a fascinating story and it is told very well. The analysis is excellent and this really provides a great perspective about how the US got to the corporate system we are now on. I wish there would be an update that would take us from 1980-2000. The debate over how socialized medicine did not take root is very interesting and well done in the book. If you are getting started or an expert this book has something for everyone. Highly recommend for those who are trying to understand how doctors and hospitals developed in America.
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on April 6, 1998
I am on my third reading of this text and can honestly say that it stands out as being the definitive text on the history of health care delivery in this country. If you wish to understand why things are the way they are in the U.S. health care delivery system, this is where to start.
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on October 17, 2003
This book traces the evolution of America's disjointed healthcare system, from the horror of the early hospitals to the formation of the medical profession. It also explains how, as the early profession was fighting for the right to exist, it took virtual possession of the rest of the healthcare system. Every Democratic president since FDR has attempted some type of major healthcare reform, only to be opposed by the American Medical Association (AMA) because organized doctorhood thought it had too much to lose.
This book is an effortless read for students of sociology or those that have a great interest in the history of medicine. Published in 1983, it easily predicts some of the current problems in American healthcare, because the powerful interests that determine the delivery of healthcare are still the same. It also predicts some of the circumstances that will finally bring America around to some sort of rational, universal, healthcare coverage.
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on July 10, 2005
This is a must read for understanding American medicine. It actually has a straightforward point of view in its focus on the autonomy and status of the medical profession and the distinguishing feature in the evolution of health care institutions. The role of the medical profession in health care is unique in our society and this books historically follows how the profession has used its position to counter capital enterprise and public programs to meet pressing social needs. He makes clear that the development of valid scientific theories and their applicating into effective treatments was critical to affirming the control of physicians. Otherwise the political disputes over licensing and accreditation could not have succeeded. Obviously the emergence of HMO's and other health insurers represent the latest source of conflict. Again this work presents the issues clearly and objectively.
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on May 30, 1998
This is the best book on the subject. It is a friendly read and provides a great overview of the history of medicine. There are some great stories in here and it is actually fun to read. Wonderfully written and a great source of information. You have to read it to believe it.
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on June 11, 2010
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.
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on August 20, 2009
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.
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