CONTENTS


Preface

Acknowledgments

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 A 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 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

Notes

Index