In his final chapter, Starr discusses the rise of the corporation, how the medical system managed to inadvertently increase its attractiveness to corporations, and the complex effects that will result in the medical field and its patients as a result of integration with the corporate model.
Three things stand out to me the most:
1) The "benefit" of corporate integration to doctors.
2) The benefits of increased oversight to patients.
3) The harms of corporate integration to people.
Starr's analysis of of corporate integration's effects on medical professionals is complex. On one hand, Starr describes that trends with younger medical professionals suggests that they have moved away from the sometimes overbearing demands inherent in individual practices, suggesting that more doctors may welcome the convenience of corporate run group-medicine, such as group practices or hospitals. This seems like a rational trend as our work market shifts into prioritization of order and streamlined convenience.
Additionally, with no little irony, he describes the sacrifice of autonomy--that which motivated the better part of the medical profession to establish and block policies since the 1800's--that will be inherent in incorporation. This places my reaction in no little sense of irony either. Largely, Starr's depiction of the medical movement has caused me to feel criticism for the professionals involved because of their fervent need to protect their own interests first above the interests of their patients. Up until then, this has been largely due to their need for autonomy and professional gains. However, now I wonder if the modern medical professional could still be guilty of prioritizing self-interest over the patient but through the relinquishment of autonomy.
In the debate over access for the poor an the needy, before insurance this was largely controlled by professionals establishing their own fees. There is surely more of an intimate, ethical, and moral consideration required in these practices. With the advent of insurers and corporations, perhaps medical professionals are much more enticed to never have to consider the issue of access again. Similar to their desire for more regular hours, perceiving their position to be framed more and more as a regular 9 to 5 job, perhaps they are happy to be rid of the ethical and moral considerations of access and equality, allowing the corporation and the insurers absolve them of responsibility. Are their interests still vested in the same ways, but expressed through an ironic reversal of demands?
Starr also outlines 5 reformations of the health practice through corporations and one of them seems to actually posit some benefits for patients. By horizontally and vertically compiling industries, corporations can limit compartmentalism of services, an issue that University of Michigan Professor and head of Obstetrics and Gynecology Timothy Robert B Johnson, categorized as one of the three "biggest threats to women's health" in a lecture in 2007. By making all levels of services available through a single hub, patients can benefit from a major barrier to access. Whereas patients could have suffered from a unintentional or intentional lack of information or services, creating a comprehensive medical home can provide patients with all their options.
However, the final issue that I intended to broach also described the very real concern with corporationalized medical care--actual access. The nature of corporations is to build upon profit and the capitalistic model. There is no gain to serve those who cannot pay,a s Starr points out, and any action to provide services for those who cannot pay would only revisit the issue of an amendment or side-service to a larger structural problem. The paradigm issues I mentioned in previous posts remain. And though I have described some of the real benefits to patients above, what good is fantstic service if you can't even get through the door?
Perhaps we can hope for a restructuring soon that will incorporate these beneficial aspects of corporationalization while ensuring access for all, but until that paradigm shift occurs, I am skeptical. Will our nation's most recent bid for health care reform actually lad us toward an oasis, or will it only bring us unfruitfully closer to another mirage?
No comments:
Post a Comment