title: Health care reform: what history doesn't teach.
abstract: The paper begins by tracing the historical development of American medicine as practice, profession, and industry from the eighteenth century to the present. This historical outline emphasizes shifting conceptions of physicians and physician ethics. It lays the basis for showing, in the second section, how contemporary controversies about the physician's role in managed care take root in medicine's past. In the final two sections, I revisit both the historical analysis and its application to contemporary debates. I argue that historical narratives can function as "master narratives" that suppress or leave out historical facts. I bring to the surface what is covered up by the master narrative approach, and show its relevance to contemporary ethical debates. I conclude by proposing that preserving the integrity of medicine will require modifying the master narratives we tell about physicians. The integrity of medicine also offers new perspectives for thinking about managed care and the broader topic of health care reform.
authors.affiliation: Department of Medical History and Ethics, School of Medicine, University of Washington, Seattle, WA 98195-7120, USA. nsjecker@u.washington.edu
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Jecker
mesh_terms: D000574:American Medical Association; D032781:Codes of Ethics; D004992:Ethics, Medical / Q000266:history; D018166:Health Care Reform / Q000266:history / Q000458:organization & administration; D006666:History of Medicine; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008329:Managed Care Programs / Q000266:history / Q000458:organization & administration; D033262:Narration; D014481:United States