History and Health Policy in the United States: Putting the Past Back In

By Rosemary A. Stevens; Charles E. Rosenberg et al. | Go to book overview

Rosemary A. Stevens


Chapter 3
Medical Specialization
as American Health Policy
Interweaving Public and Private Roles

Life usually doesn't just dump truth on
your plate, neat and simple. It usually
comes with a side of nuance, garnished
with paradox
.

Chris Satullo, Avoid the Dreaded Either/Or—
Seek the Sweet Bird of Paradox

What is health policy? On the face of it, there seems a simple answer. Health policy is what governments do, or try to do, to further health care, typically at the national level. As other essays in this volume resoundingly attest, however, seeing health policy only as what government does or fails to do gives a blinkered, partial—and much too tidy—view of the rich, complex, and constantly shifting landscape of health policy in the United States. I want to suggest some of this complexity, nuance, and paradox by examining specialization in American medicine as a vital, yet often neglected, policy issue.

Public and private policy making have long been entwined in American politics. Specialization weaves together several histories: the history of government, to be sure, but also the histories of science and technology, the medical profession, health care, business, consumerism, and other more generic historical fields. I concentrate here on the history of the U.S. medical profession, which is now formally structured—through education, examination, and certification—into thirty-seven primary specialties and ninety-two subspecialties

-49-

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