Commodifying the Polyvalent Good of Health Care

Abstract

This essay serves as an introduction to this issue of the Journal of Medicine and Philosophy on commodification and health care. The essay attempts to sharpen the articulation of generally expressed worries about the commodification of health care. It does so by defining commodification, analyzing three components of the good of health care, and attempting to assess how commodification might distort the shape of each of those components. Next, it explores how the good of health care might be distorted by the market-based principle of distributive justice, "to each according to ability to pay." Finally, it identifies two basic questions about the relationship of medicine and the market that merit further exploration. (1) How does the market-based language of "incentives" so pervasive in the world of managed care distort the complex patterns of virtue and vice that motivate actors in the health care arena? (2) If we recognize that we cannot eliminate the influence of money from the health care system, how can we insure that the good of health care remains, in Radin's terms, "incompletely commodified"?

Assessing common(s) arguments for an equal per capita allocation

“…According to Kaveny (1999), a commodity is something that has a price, is fungible and is of instrumental rather than intrinsic value. By this definition, fossil fuel is clearly a commodity.…”

Health Care as a Community Good: Many Dimensions, Many Communities, Many Views of Justice

“…In the words of Michael Walzer, “all distributions are just or unjust relative to the social meanings of the goods at stake.” 1 So too with health care. Over a quarter century ago, Robert Veatch held that “any abstract argument about distribution principles in health care without pinning down precisely what is being distributed will be fruitless.” 2 Nearly a decade later, in the first book‐length treatise on justice and health care, Norman Daniels noted the futility of applying general theories of justice to health care without knowing “what kind of social good health care is.” 3 Recent discussions of the commodification of health care—that is, of the changing nature of health care as a social good—highlight its implications for just health care 4 …”

More Questions than Answers: The Commodification of Health Care

“…Underlying this use of market forces is the assumption that health care can be treated as a commodity. This assumption about the nature of the goods of health care raises as many questions as it answers (Kaveny, 1999;Callahan, 1999;Pellegrino, 1999;Hanson, 1999;Cohen, 1999). Daniel Callahan has clearly laid out important questions and moral issues that must be examined as any move toward a market strategy in health care is undertaken.…”

“…A key area of confusion and debate, I suspect, is the understanding of health care itself and the different ways in which the term health is used and the different models of health and health care that can be deployed (Kaveny, 1999). Many of the discussions about commodification and markets often make unarticulated assumptions about the very nature of health care itself.…”