Plucked by Herzig Rebecca M

Author:Herzig, Rebecca M.
Language: eng
Format: epub
ISBN: 9781479840250
Publisher: NYU Press

THE REMARKABLE DIFFUSION of these new tools was made possible by the changing economic and legal context of American medicine. Beginning early in the 1960s, increased public funding for poor and elder medical care through Medicare and Medicaid and a maturing postwar baby boom generation led to growing concern about a shortage of physicians in the United States. In response to these concerns, the federal government began pouring money into medical education, which resulted in a doubling of the annual number of U.S. medical school graduates between 1965 and 1985.22 The same years witnessed the expansion of the J-1 visa program, founded to enhance medical provision to underserved rural areas. The J-1 program brought rising numbers of international medical students and graduates to the United States for education, residency, and employment.23 Growth in the medical training and licensing of U.S.-born students, combined with increased migration to the United States by foreign medical graduates, produced a spike in the number of licensed physicians practicing in the United States: there were 148 non–federally employed physicians per 100,000 persons in 1970, but by 2000 there were 288 per 100,000—nearly twice as many.24

As it turned out, neither federal nor private expenditures for medical care kept pace with original 1960s projections, leading to a glut of highly trained practitioners. Underemployment produced increased competition among doctors, which in turn generated new strategies to increase demand for medical services. Countries with nationalized health care systems tend to regulate such strategies. In Britain, for example, the state regulates not only the overall intake of new medical specialists but also the number of practitioners working in a given specialty. The United States, however, relies largely on the market to govern such shifts.25 For some time, the American medical profession maintained an ethic of care explicitly averse to the generation of profit. This professional norm enabled some indirect regulation of medical practice, as physicians who too aggressively sought to expand consumption of their services might be subject to censure from their colleagues. But that professional norm was altered by a series of regulatory shifts in the 1970s. In an effort to rein in galloping health care costs, the Federal Trade Commission began to use existing antitrust law to overturn physicians’ self-imposed ban on personal, direct-to-consumer marketing. In Goldfarb v. Virginia State Bar (1975), the U.S. Supreme Court held that members of the “learned professions” are subject to the Sherman Antitrust Act, emboldening efforts to overturn professional trade restrictions. Other court decisions similarly collapsed received distinctions between medicine and other trades, forcing professional societies and state licensing boards to loosen their restrictions on individual physicians. This judicial shift hastened physicians’ ventures into direct-to-consumer marketing. Newly deregulated physicians, swimming in a hyper-competitive pool of underemployed practitioners, soon began advertising their goods and services in telephone books, on talk show interviews or “infomercials,” and through educational seminars.26

Increasing competition and decreased regulation resulted in the rise of “medi-spas”—free-standing units that co-opted some elements of the women-run health centers crafted by feminists in the 1970s.

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