The Social Transformation of American Medicine: The rise of a sovereign profession and the making of a vast industry

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.

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.

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.

This book really is a well-crafted historical account of medicine and how the profession has changed over the last 300 years. It is so well written that it avoids the dry and monotonous tone other non-fiction books often have. It's a great book...a fun read.

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.