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

were said to be “to the old ‘doctor’s hospitals’ what agribusiness is to the family farm.” 14 An original $8 share in Humana, a multinational health care company, in 1968 was worth $336 by 1980; investments in hospital systems during those years returned almost 40 percent more in earnings than the average for other industries. 15
    In the early decades of the twenty-first century, health care is a multi-billion dollar industry. Medical schools now offer joint MD-MBA degrees and business school graduates hold top positions in medical organizations, even though as recently as 1978, doctors weren’t expected to understand health care financing and organization. 16 Managers of both not-for-profit and for-profit hospitals, who earn salaries as hefty as those in the private sector, are rewarded based on the net income of the hospital, and hospital CEOs or presidents “are clearly accountable to their boards as business experts.” 17 Health care policies are laid out by business school professors and economists. 18
    Arnold Relman, former editor-in-chief of the New England Journal of Medicine and the man who coined the term medical-industrial complex , says the most important socioeconomic change in a hundred years of American health care is the movement from “a professional service for the sick and injured into one of the country’s largest industries” — a transformation of health care from the compassionate relief of suffering to a profit-oriented business. Relman admits, “I am not saying that business considerations were never a part of the medical profession…or that physicians were in the past unconcerned about their income…But the commitment to serve patients’ medical needs (as well as the needs of public health) and the special nature of the relation between doctor and patient placed a particularly heavy obligation on physicians that was expected to supersede considerations of personal gain — and usually did.” 19
    Biomedical ethicist Callahan agrees. “[T]here is an enormous difference,” he says, “between a discipline and a profession whose practitioners do not resist the personal good life when it comes their way, and one which has that life as its purpose.” 20 Paul Starr, a Pulitzer Prize-winning sociologist adds, “The contradiction between professionalism and the rule of the market is long-standing and unavoidable. Medicine and other professions have historically distinguished themselves from business and trade by claiming to be above the market and pure commercialism. In justifying the public’s trust, professionals have set higher standards of conduct for themselves than the minimal rules governing the marketplace.” 21
    Back in the 1960s, the norm as a doctor, according to the AMA, was to limit your professional income to “reasonable levels” because the “charging of an excessive fee is unethical…[the] fee should be commensurate with…the patient’s ability to pay…” 22 Health care was considered to be about need, not someone’s ability to pay, since health care dealt in quality of life as well as life itself. 23
    The economic story, on the other hand, says health care services are products, hospitals and doctors are sellers, and you as a patient, your government, and your insurance company are buyers. Your doctor is an entrepreneur competing with other doctors for your business. As a business, the health care industry promotes ever-changing products, “medicalizes” problems by advertising all kinds of conditions, stimulates interest in cures, builds consumer demand, and tries to get you out to the doctor more. Doctors can now be hired by insurers, which creates a conflict of interest between you and your doctor; an insurer typically wants to pay out as little as possible, so your doctor is caught in the middle, wanting to do what’s medically necessary for you as a patient while being aware that his or her employer is eyeing the cost. 24
    In short, health care as