Book Two, Chapter Five: The Coming of the Corporation

This chapter illustrates the unfortunately traditional tradeoff between efficiency and equity. While reading, I was continually struck by the perversion of patient care by the influx of possible profit. While I don't think that all consolidations are problematic and I understand the economics behind market-based health care, it remains disturbing to me that money has changed the way we provide care. The phrase "wallet biopsy" (page 436) is likely to haunt me forever. The government has worked strenuously to secure public health, first eradicating environmental reservoirs of disease, then acute individual conditions and now, individual chronic care conditions. While I agree that emergency rooms are often abused, transferring a patient to save money at the risk of the patient's life is unacceptable, for-profit hospital or not.

I also find it interesting to note that although a surplus has occurred, it has occurred unevenly. An article was recently released detailing the shortage of primary care physicians. As money was poured into specialties in the 1970s and 80s, a shortage of generalists slowly developed and persists today. Shortages also exist in certain communities. Unfortunately, market based tools are unlikely to adjust for these shortages.

Finally, the comment tying health care provision to a McDonald's hamburger is particularly revealing. On a macro level, we want health care that is effective and efficient. When it comes to health care for ourselves, our children or our parents, however, we want individualized health care, tailored carefully so as to address the individual needs of our loved ones. I am certainly guilty of this. I want health care that provides for all people, but when it comes to the needs of my sister, who is currently suffering from an enigmatic immune disorder, I want the best doctor available. One size fits all is simply not good enough for her. As we move forward and attempt to revitalize and redesign our system, we need to be pragmatic about stakeholder interests and realize that even individually, we hold conflicting values about what a health system should accomplish.