On a weekend trip to Baltimore’s reductio ad freedonium of a used bookstore, a k a The Book Thing, a warehouse full of books that are yours for the taking, I finally got my hands on The Social Transformation of American Medicine. It’s a classic for its sociologic description of how American medicine got this way: physicians managing to hold onto their control by dint of social and economic power. The book is 30 years old but its conclusions are still spot on.

As with any great work of history, the reader wonders if the clock can be turned back without sacrficing what we have gained. It used to be, shows Starr, that sickness was treated at home; laypeople acted as their own practitioners; and physicians had difficulty maintaining the social prestige that enabled them to set their own fees and wall off outsiders from their guild.

Of course, we wouldn’t like to return to all of this. But we could imagine a health care system which involves a multiplicity of certified, qualified providers, and a greater inclusion of common sense which recognizes that for some common and nonserious conditions, a layperson can treat herself at home without any advanced imaging at all.

Can we get there from here?