Starr, P. (1982). The social transformation of American medicine: The rise of a sovereign profession and the making of vast industry. USA: Basic Books.

In The Social Transformation of American Medicine, Paul Starr offers the reader a sweeping, thorough, and detailed history of the American medical profession. Book One interrogates American medicine’s establishment of sovereign cultural/ professional ethos and developing socio-economic dynamics from approximately 1790 to 1930. Book One traces the American medical establishment from fledgling pseudo-profession to cultural elite. He explores the transition from a time of no medical licensure when medical schools offered degrees of little more substance than a specialized high school diploma to the development of the AMA, state-controlled licensing boards and the establishment of the MD as graduate degree. Book One traces the competition among various approaches to healthcare including the not only the confrontations between allopaths and homeopaths, but also botanical physicians, osteopaths, chiropractors, and psychologists.

Book One also traces the establishment of the early medical system including the rise of hospitals and the role of public health. Starr explores how predominantly church or charity run dispensaries transformed into or were replaced by the modern hospital, and how the dominant paradigm of medical care transitioned from home to hospital. Starr also explores how the microbial revolution fostered a change from public health as little more than public sanitation to a vast program of inoculation and medical intervention.

Book Two picks up where Book One leaves off, in about 1920, and traces the rise of the insurance industry, the role of governmental regulation, and the development of medical corporations. Starr offers a compelling history arguing how the rise of unions and the demand for benefits fostered the establishment of an early insurance industry. Starr then explores how this establishment of third-party payment led to the a tremendous inflation in the cost of healthcare in the US. He also explores how various AMA and governmental policies led to a serious physician-shortage that lasted into the 1980s and exacerbated healthcare cost inflation. Finally, Starr argues that a then-recent backlash against the unquestioned sovereignty of the medical profession has created an environment where physicians once again feel the need to secure their position. He agues this need to secure their positions has resulted in the significant corporatization seen of the healthcare industry.