ABSTRACT
The organizational parallel to pluralistic insurance arrangements in the United States has been representative structures for the medical profession that are fragmented and opportunistic, based on specialty interests rather than on the profession as a whole. In the absence of effective governmental, nonprofit, or market-driven health care strategies, the medical profession became a convenient villain for failures elsewhere in health care policymaking. Its villainy was enhanced by the powerful narratives of failure that were built into conceptual explanations of the profession's larger social role: the decline in professional authority, with the medical profession overcome by the power of public disillusion and then by the more potent power of insurers. The doctor-patient relationship, a core value of professionalism, is at the heart of current medical critiques of physician relations with managed care corporations. Historical narratives dominated by the story of organized medicine's rise and fall, suggesting a defeated profession, have sustained its weakened political status.
