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April 20, 2010
In her review of Denis G. Arnold (ed.), Ethics and the Business of Biomedicine Lisa Newton highlights the core issue: the recent move of the professions of health care from a service orientation to market orientation. This is crucial transformation and it is what sits behind the politics of health care reform with its emphasis on the healthcare institution-patient population" dyad.
Arnold's brief to the authors was:
to evaluate the practices of profit-seeking healthcare organizations, and business-friendly public policies regarding health care, and to offer normative guidance regarding the ethical delivery of healthcare products and services by profit-seeking organizations operating in a global marketplace. (p. 1)
Newton poses several questions:
If health care seeks profit, it will surely find it -- there's nothing we want so much as freedom from pain and a long active life, and to the extent that we have money, we'll pay the earth to get them. People without money will not be able to get them, of course, but then they can't get expensive sports cars, either, and we don't mourn over that. Is health care radically different from sports cars, or even music lessons? If not, whence the controversy? And if it is different, then maybe pursuit of profit is totally alien to the profession.
The corruption of the medical profession by the pharmaceutical industry, the latter's penetration of medical education and practice, the conflicts of interest for the medical profession, and the consumer's increasing distrust of the profession come to mind. Medicine is a business,and we have experienced the corporatization of medicine, and big business (eg., private health insurance) in the free market. That means profitability for the corporation (the profit machines of the insurance industry) but not necessarily better human health.
The other aspect is the use of market instruments to help manage the rising costs of health care in public institutions and the ideology of "market" mechanisms, premised on the freedom of every consumer to make "his own" choices and take full responsibility for them. Though some hold that for-profit enterprises can be "disciplined" into adopting goals aligned with traditional medical practice, I doubt this.
Corporate medicine is a very different beast to the traditional medicine of the old family doctor and the "doctor-patient" dyad. An insurance company contemplating the effects of our policies and practices, doesn't care about the pain they produce, or countenance, and as long as they have investors scanning the quarterly returns.
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