Monetized medicine: from the physical to the fiscal

Abstract

This paper explores professional rivalries as one force driving market-driven healthcare. Extending their jurisdiction beyond industrial settings, industrial engineers calibrated the physician's labor against fiscal metrics by devising product lines for hospitals. These products––diagnostic related groups (DRGs)––were not, however, intended as commodities. Economists, in contrast, proffered theoretical arguments justifying why medical care was best provided using market-like mechanisms. They assumed care as a commodity. The passage of the law mandating prospective Medicare payments for DRGs created a functioning market in care by identifying the products of engineers with the assumption of economists. Accountants, meanwhile, took this as a business opportunity to increase revenues. The transformation of medical service to care was intended to reduce runaway medical costs. Market-driven healthcare has resoundingly failed to fulfill that intention. Nevertheless, it has won a symbolic success. The trade in care also implies a merger of the physical and the fiscal and puts a “price on life”. The fact that much of medical practice and ethics presuppose health as a matter of wealth says that life and death, no less than health and sickness, are professional artifacts and commodities rather than natural phenomena.