Comment: What Historians of Medicine Can Learn from Historians of Capitalism

Medical care is deeply intertwined with economics, as anyone who has tried to navigate the U.S. health care system is painfully aware. The "New History of Capitalism," Christy Chapin argues in her rich and fascinating essay, can help scholars analyze and better understand this relationship. Chapin invites medical historians to apply a "broad" and "capacious" definition to the term "capitalism" in order to locate capitalist features like markets, profitmaking, and commodification throughout the history of health care. In doing so herself, Chapin makes some new and surprising observations about this history, including defining some ancient and medieval religious healing practices as capitalist, and twentieth-century physicians as anticapitalist.

I learned a great deal about the New History of Capitalism from this essay, and I hope that historians of medicine will take seriously many of the field's important insights, especially its call to historicize "the economy" and analyze its particularities in different times and places. The work of the "new" historians of capitalism has helped me think about how my own work on twentieth-century U.S. health care history has mostly taken "capitalism" for granted, assuming that it was the context in which historical actors operated but not examining its composition or dynamics. I appreciate the opportunity to think more analytically about how health care in the United States has both been shaped by and contributed to modern capitalism. (Since I am more cowardly than Professor Chapin, my comments here focus solely on my own field, twentieth-century U.S. health care history.)

Historians of capitalism call upon scholars "to denaturalize capitalism and 'the market,'" Chapin tells us, and to study "how power relationships are manifested through economic operations" (pp. 325–26). Yet these important goals at times contradict how some prominent spokespeople for the "new" history of capitalism have juxtaposed economic history against social and cultural history, and have chided social and cultural historians for abandoning economics.¹ Instead, we should not lose sight of how the economy functions and changes in relation to culture and society. As cultural historian Nan Enstad argues, summarizing the British Marxist cultural theorist Raymond Williams, "The terms 'economy,' 'culture,' and 'society' should not be treated as separate arenas of life nor as fully separable categories of analysis: their power for analysis comes from their interrelationship."² I would add "politics" and "ideas" to this list.

While she acknowledges the complexities and challenges of definition, at many points throughout her essay Chapin seems to define capitalism solely as competitive markets. This is particularly evident in her depiction of physicians in Germany, Britain, and the United States as anticapitalist, and modern health care systems as shaped by "the antagonism of organized physicians toward capitalism" (p. 344). However, if we define capitalism not simply as markets but as a particular arrangement of markets that also embodies ideology and power relations, society and culture, then organized physicians' response to health reform in the twentieth-century United States (again, I am speaking of that country only) looks more like a robust defense of the capitalist system. In opposing both government intervention and third-party competition, physician leaders argued that their profession's autonomy was central to an American identity rooted in individualism, private property, and free enterprise. This was not just a matter of rhetoric; in its ideological and strategic alliances with powerful capitalists including business groups and the insurance industry (which Chapin has so well described for the later period in Ensuring America's Health), organized medicine in the United States built its political influence in a way that had tangible consequences for the health care system. In just one example from the period the essay discusses, in 1919 the Medical Society of the State of New York joined with commercial insurance companies and the New York manufacturers' association—the quintessential capitalists of their time—to craft the legislative strategy that killed proposals for compulsory worker health insurance.³

Certainly, this was a way for physicians to have their cake and eat it too: to serve as shining beacons of capitalist self-reliance while rejecting...