Commercial Pressures on Professionalism in American Medical Care: From Medicare to the Affordable Care Act

See Durkheim E. , Professional Ethics and Civic Morals, Brookfield C. , trans. (Westport, Conn: Greenwood Press, 1983). Veblen T. , The Higher Learning in America (New Brunswick: Transaction Publishers, 1993); Tawney R. H. , The Acquisitive Society (New York: Harcourt, Brace and Co., 1948). Haskell T. , “Professionalism versus Capitalism,” in Haskell , ed., The Authority of Experts: Studies in History and Theory (Bloomington: Indiana Univ. Press, 1984): 180–225.

For documentation of the decline of professional authority, see, among many works, S. Brint, In an Age of Experts: The Changing Role of Professionals in Politics and Public Life (Princeton: Princeton Univ. Press, 1994) and Krause E. A. , The Death of the Guilds: Professions, States and the Advance of Capitalism 1930 to the Present (New Haven: Yale Univ. Press, 1996).

See for this documentation and explanation, C. Tuohy, Accidental Logic (New York: Oxford University Press, 2000).

For further discussion of the Canadian experience in comparative terms, see Marmor T. Freeman R. Okma K. , eds., Comparative Studies and the Politics of Modern Medical Care (New Haven: Yale University Press, 2009).

This discussion of the language of professional commentary draws on Marmor T. R. , Fads, Fallacies and Foolishness in Medical Care Management and Policy (Singapore: World Scientific Publishing, 2009). See especially chapter one.

This article in not the appropriate place to discuss at length the long, contentious, and continuing argument about user charges in medical care financing. There is a series of seven papers that two decades ago reviewed the literature on the subject for the Ontario Premier's Council on Health, Well-Being and Social Justice in 1993. Those articles are available from the University of British Columbia's Centre for Health Services and Policy Research. For a summary of them, see this article: Evans R. Barer M. L. Stoddart G. L. , “User Fees for Health Care: Why a Bad Idea Keeps Coming Back,” Canadian Journal on Aging 14, no. 2 (1995): 360–390. Their perspective is clear. see especially Evans R. G. , “User Fees for Health Care: Why a Bad Idea Keeps Coming Back,” Health Policy Research Unit Discussion Paper #93–9D, 1993. While the work of Evans and his colleagues is well known in other industrial democracies, they are hardly cited at all in the health economics literature published in the United States.