Ironies of Success: A New History of the American Health Care "System (original) (raw)

Medicine at the turn of the century

The Annals of Thoracic Surgery, 2000

T he delivery and the cost of health care are once again the focus of great public attention. The defeat of the Clinton health-care plan in the 1990s initiated the fastest and most sweeping changes ever in our health care system. Although the plan was conceived in idealism with an intention of providing universal coverage, it went nowhere, in large part because of the political ineptitude of our national leaders and the lobbying efforts of the insurance industry. In the process, government has essentially been eliminated as the prime mover in the organization of health care in favor of a massive experiment in which private health-care markets now deliver and manage care. Many involved in this conversion simply consider health care a marketable commodity.

The Continued Social Transformation of the Medical Profession

2010

A pressing concern in contemporary health policy is whether the medical profession's mandate to take care of clients has been undermined by the influx of money into health care. We examine the medical profession's transformation over the past decades. First, we review how sociologists have viewed the medical profession over the past half-century as one stakeholder among other stakeholders vying for market share and power in the health care field. We then examine three recent challenges to the profession that exemplify the tension between self-interest and collective altruism to act in the best interest of patients: (1) the rise of patient consumerism, (2) the advent of evidence-based medicine, and (3) the increasing power of the pharmaceutical industry. We show the resilience of the medical profession as it adapts and transforms in response to these challenges. We conclude with implications to help inform policy makers' assessments of how the medical profession will react to policy initiatives.

A Loss of Faith: The Sources of Reduced Political Legitimacy for the American Medical Profession

The Milbank Quarterly, 2002

W riting at the beginning of the 20th century, Shaw identified one of the significant contemporary transformations in industrial democracies. In part as the result of advances in science and technology, in part as a rejection of the monopolistic abuses of industrialization, and in part as a consequence of assiduous efforts by the professions themselves, this was a period in which the legitimacy and social authority of professionals increased dramatically (Brint 1994; Krause 1996; Larson 1977; Sandel 1996). Nowhere was this more evident than in medicine. Over several decades, medicine changed from an occupation with a mixed reputation and little political influence into one that would "dominate both policy and lay perceptions of health problems" (Freidson 1994, 31). In a number of countries, the professional authority and political influence of physicians also

The Political Economy of Health and Medicine

Monthly Review, 1988

Crisis, Health and Medicine is a collection of Vicente Navarro's essays developing the thesis that the crisis of medicine is inseparable from the recurring crisis of capitalism. Crisis in medicine has been described as the continued rapid escalation of costs in the face oflittle or no improvement in health for the nation or the world. In the United States nearly 11 percent of the gross national product is devoted to medical care and yet much of the care available is inappropriatedependent on high technology, hospital-based, and fragmented by specialization. Fully one quarter of the U.S. population is uninsured or underinsured. And despite evidence that the health of any nation is historically more dependent on social factors-primarily the standard of living associated with class-than on specialized medical intervention, the concentration of capital into high-cost and "hightech" medical care continues. Do policy makers and professionals allocate resources in this manner because they cannot read the evidence, or haven't been apprised of the public health studies? Does some conspiratorial plan exist in which those who profit from medicine conspire to keep the population sick or keep them demanding more expensive medical care, or to exclude various groups from care? Navarro argues that this is not the case. As he puts it, "the bourgeoisie does not lie ... nor does Roberta Lessor teaches sociology at Chapman College and social and behavioral medicine in the Primary Care Program at the University of California, Irvine. Howard Waitzkin teaches internal medicine and social sciences at U.C. Irvine.

From tragedy to farce: On medicine, the state and the market

Journal of Historical Sociology, 2007

This speculative essay is prompted by the formal characteristics of contemporary debates over the progress of medicine, namely their oscillation between claims about ever greater possibilities and dire warnings about threats to fundamental human values, and by a troublesome, yet resonant, phase from Nikolas Rose's reflections on contemporary governmental mechanisms. It seeks to push the terms medicine, state and market to their conceptual limit, and raise question thereby about what might be the most appropriate comportment towards these debates.