When did good health become a commodity, a good that is bought and sold, accessible only through the exchange of capital and brokered deals?
When did healthcare morph into the corporate machine that it is now, turning patients into "consumers" and reducing physicians and healthcare professionals to "providers"?
When did hospitals start placing a higher economic value upon medical decisions that make patients happier, above medical decisions that make patients healthier?
Famed anthropologist Arjun Appadurai defines a commodity as "any thing intended for exchange".
Health outcomes themselves are impossible to commodify, but our society has placed an exorbitantly high economic value upon the health services - the commodities - that play a large part in determining those outcomes. In a healthcare system that disproportionately favors the rich over the poor, the life expectancy for lower-income Americans is about 5 years shorter than that of the affluent.
Over the years we have witnessed the transformation of healthcare into a market-driven system that is completely at odds with the human understanding of what good healthcare should mean. The physicians, clinicians, and specialists are no longer the ones running the show. Thousands of large-scale, long-term healthcare decisions are made every single day by the administrators and businesspeople behind the scenes of a corporate healthcare machine.
When healthcare is nothing more than a commodity to be bought and sold, medical decisions become driven by market interests, and physicians and patients are reduced to their roles in the respective markets of supply and demand. This oversimplification of the medical process has led to large flaws in the healthcare system and broad disparities between costs and outcomes.
We can see this consumer-driven logic and its underlying issues play out in the aggrandized importance of patient satisfaction surveys that hospitals are more frequently using to evaluate physicians. After all, the commoditization of healthcare means that patients are customers - and in a capitalist market environment, isn't it true that the customer is always right?
Unfortunately, the patient is not always right. But such a system rewards physicians who bend over backwards to accommodate their patients even when they know better, driving up healthcare costs and impairing health outcomes. The patient didn't go to medical school - so why is the patient making the decisions? Because the patient is the one with the checkbook, and healthcare is now a system driven by cash flow and revenue cycles, not good health and positive health outcomes.
In a healthy economic market, a higher price does indicate a better quality good or service, so people (mistakenly yet understandably) believe that if they pay more for health services, they will be healthier and live longer. The underlying issue is that you can't put a price tag on good health or a few extra years of life. You can put a price tag on health services - but the price tag will not necessarily reflect the true value. This is indicative of an unhealthy dysfunctional market, in which the only winners are the industry giants collecting on a wide profit margin.
The commodification of healthcare has lead to a defunct system that frustrates physicians and patients alike. It might be worth the frustration if health outcomes were improving at the rate of health costs, but they aren't. The nature of this system damages patient-physician relationships, deteriorates medical ethics, contributes to physician burnout, and drives up the costs of health services - without doing much to improve the actual health outcomes.
The example of patient satisfaction surveys is symptomatic of a much larger issue with the system. Medicine is complicated, healthcare is complicated, and reducing the participants to pawns in a chess game between industry, provider, and consumer may be convenient for board meetings and executives, but it is not an effective way to administer healthcare. Health is not an ordinary economic good, and treating it as such is deleterious to the fundamental concept of medicine.
By treating healthcare as a commodity we have inadvertently denatured the doctor-patient relationship, created an insidiously dysfunctional system, and alienated our fundamental human values. There is no easy solution or "quick fix" for this problem. But understanding the conceptual flaws in treating health as a tradable commodity will bring our society one step closer to finding a way out of this mess.
