Monetized medicine: from the physical to the fiscal

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.