In Sickness and In Wealth: American Hospitals in the Twentieth Century

American hospitals are a unique combination of public and private institutions that are at once charities and businesses, social welfare institutions and icons of US science, wealth, and technical achievement. In Sickness and in Wealth helps us understand this huge and often contradictory “industry” and shows that throughout this century the voluntary not-for-profit hospitals have been profit-maximizing enterprises, even though they have viewed themselves as charities serving the community. Although our hospitals have provided the most advanced medical care for acutely sick and curable patients, they have been much less successful in meeting the needs of the chronically ill and the socially disadvantaged. That, Stevens concludes, is the next urgent task of social policy.


“[A] fascinating, panoramic survey of the evolution of the American hospital system in the twentieth century... Stevens brilliantly views the hospital as a prism of the values and mores of society... She sees the stratification of the hospital population into private, semi-private, and charity patients as a manifestation of the social stratifications of American society... Stevens has written a profoundly important book. Together with The Care of Strangers (1987) by Charles Rosenberg, In Sickness and in Wealth provides a masterful overview of the development of the American hospital system. These two outstanding books complement each other neatly. The Care of Strangers examines the creation of the system from 1850 to the 1920s; In Sickness and in Wealth traces events once the system was in place through the present. Rosenberg’s book is an unusually well crafted piece of social and cultural history; the present book is written to a much greater degree from the standpoint of political science, and it also carries more implications for present-day policy issues. Ambitiously conceived, superbly executed, and rich in detail, interpretation, and insight, In Sickness and in Wealth is a major work of scholarship that will influence discussion of the health care system for years to come. It has all the makings of a classic.”― Reviews in American History


“This book is beautifully written... and is must reading for anyone involved in the current debate on health policy. It will also make delightful reading for those who merely wish to view the shifting social and economic climate in modern America, as seen from the perspective of the hospital.” ― New England Journal of Medicine


“[S]uperbly researched, and rendered in an engaging style that combines the policy analyst’s breadth with the historian’s fine sense of detail.” — New York Times


“[A]n ambitious and impressive survey of a medical-care system that deserves to be called an industry.” — Los Angeles Times


“The book is encyclopedic in its analysis as well as in its detail; it can be read as a fascinating history of twentieth-century medicine, as a powerful analysis of contemporary social policy, and as an exploration of American values.” — Isis


“[A] masterful picture of the emergence of the hospital and its role in American society.” — Science