The Books of My Life: The Social Transformation of American Medicine

Modern social theory often had in the 18th, 19th, and,  early 20th centuries a historical component at its heart. Henri de Saint-Simon, Auguste Comte, Karl Marx, Ferdinand Tönnies , Max Weber, and Emile Durkheim all attempted to understand the changes in society and culture that they saw taking place as they wrote. They were, after all, living in an era when traditional societies were being replaced bit by bit by modern ones.

Historical sociology may have declined in the era when academic disciplines were being segmented and their labour specialised but historical sociology, even if negatively impacted by specialisation, did not die. Robert Merton wrote about the rise of science. Barrington Moore explored the roles lord and peasant played in the rise of "democratic" and "autocratic" modern societies. Keith Thomas, in his magnificent, Religion and the Decline of Magic--a book that had a massive influence on my intellectual life--explored demagicification in 16th and 17th century England. Even Talcott Parsons, probably the leading social scientist from the 1930s to the mid-1960s, got into the act publishing two volumes late in life in an attempt to provide functionalism with a historical frame. Paul Starr published his sociological history of American medicine in 1982.

Starr's The Social Transformation of American Medicine: The Rise of An American Profession and the Making of a Vast Industry (New York: Basis, updated edition, 2017) explores the history of American medicine, its doctors, its hospitals, its insurance companies, and the impact of public policy and governmental action had on all three. Starr argues, rightly in my opinion, that a historical methodology is essential to understanding the changing fortunes of the power, authority, and influence of American doctors (decline in Jacksonian America, rise of monopoly power in the Progressive Era thanks to the increasing authority of science; under threat beginning with the New Deal, increasingly corporatised and specialised), the transformation of hospitals (from charities to places of healing, increasing corporatisation), the history of medical insurance (the rise of non-profits, for profits, Medicare and Medicaid), governmental policy toward doctors, hospitals, and the insurance industry, the impact the private economic sector on the American medical system, and the interrelationships between all of these that gave rise and helped to create and bring about changes to the American medical system economically, politically, culturally, geographically, and demographically.

When Starr's book was first published University of Wisconsin historian of science and medicine Ronald Numbers said that it was the book that those interested in the history of American medicine needed to read. Thirty-seven years it still is. Starr's book shows quite clearly that a historical approach is necessary to understanding the American medical system. He also shows that a social theoretical approach is also necessary to an understanding of how the American health system works. Very highly recommended to those interested in how American medicine and the satellites that surround it became what they are today. It is a pity that those who most need to read Starr's book won't since they prefer the ideologically and politically correct myths they parrot to reality. What also is not likely to change is the American care cycle of the recent past, a cycle in which the American health care system lurches from crisis to crisis with bandaids being put on its many sores by the powers that be, bandaids, which, in the final analysis, do little to solve or salve the long term disease at the heart of the American health care system.