Free Monoculture: How One Story is Changing Everything by F.S. Michaels

also softened by the ideals that dominated the culture of the medical profession. 7 In 1934, the ethics code of the American Medical Association (AMA) said non-doctors (outside investors) profiting from medical work was “beneath the dignity of professional practice, is unfair competition within the profession at large, is harmful alike to the profession of medicine and the welfare of the people, and is against sound public policy.” 8
    Before World War II then, medicine was a cottage industry financed mostly by wealthy patients and philanthropists. Not enough medical technology existed to support a health manufacturing industry, and the government was uninvolved in health care other than via licensing and tax laws. In 1946, most American citizens were uninsured and paid for medical services out of their own pocket, or sometimes paid in kind. But in 1946, medicine was also viewed as a profession, not a business. A patient’s medical needs, by and large, were put ahead of a doctor’s financial gain.
    After the Second World War, funding that had gone to the atom bomb was redirected to medical research, and in the 1950s and ’60s, major advances were made in surgery, radiation, chemotherapy, organ transplants, and tranquilizers. Medical knowledge had now grown too large for a single doctor to learn during training, and doctors increasingly began to specialize. In 1923, 11 percent of American doctors were specialists; in 1989, over 70 percent were. Specialists were paid more than generalists and enjoyed more prestige, but specialization also meant that a doctor’s once-holistic view of you as a patient became fragmented, and personalized medical care started to fade. 9
    With the rise of new medical technology, along with specialization, insurance coverage, and unregulated payments for doctors’ fees, medicine started looking attractive to outside investors. In the late 1960s and early 1970s, Wall Street started investing in for-profit health care facilities like investor-owned hospitals, nursing homes, home care, labs, and imaging services. 10 After an advertising ban in medicine was lifted, doctors and hospitals started advertising their services. Where open and public competition between doctors and hospitals had once been considered unethical and unprofessional, advertising now made that competition public, which strained collegiality. 11
    As investors started showing interest in health care, medical costs started to spiral due to inflation, growing research expenses, rising doctors’ fees, higher hospital costs, more health benefits for employees, and an aging population (medical advances had lengthened our lives but now we faced the complications of chronic disease which we just hadn’t survived to experience before). Malpractice suits were also rare until the twentieth century, when a growing number of lawsuits created “defensive medicine”: doctors did everything they possibly could in a medical situation to avoid being sued for negligence. 12
    Technological advances in medicine were also proving expensive. Though new technology usually pays for itself because machines replace workers, in medicine that didn’t happen. Instead, medical advances involving complicated equipment and procedures required additional experts to be trained in the technology and increased costs instead of decreasing them. 13
    The market was presented as a solution to all of these problems. The economic story says that a health care market will bail the government out of health care support it can no longer afford. Medicine started taking on the management practices of large businesses, and industrialization techniques were applied in the field. Private capital became a major player in the system, and much of the money was tied up in insurance companies and manufacturers of health technology. For-profit health services appeared in home care, kidney dialysis centers, care centers, and hospitals. Multinational health care companies grew and