Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 220.127.116.11. If your access is via an institutional subscription, please contact your librarian to request reinstatement. If you are using a personal subscription, please contact the Duke University Press using the Contact Us form.
Administrative changes have been reshaping health policy for the past decade. One consequence is a more constrained medical profession. Another is a more powerful health care bureaucracy. Most industrialized nations have called on democratic principles to balance professional norms; in contrast, Americans are developing a distinctly bureaucratic health care regime. This article suggests why and explores the ramifications for both the politics of health care and the practice of medicine.