Inequalities of Modern Healthcare
Modern medicine is increasingly influenced by economic interests:
Originally providing a social critique on the capitalist economic structure of the mid-nineteenth century, today Marxist critique mirrors developing trends within modern medicine and the healthcare system.The Marxist model explains an evolving definition of health, as medicine becomes shaped by corporate interests in a highly capitalist society. The movement of healthcare from a local public service to being driven by the intentions of large corporations encourages a social division and inequality between classes.
According to basic Marxist philosophy, healthcare originally facilitated profit-making of other industries by reducing illness that affected productivity. In this capacity the motivations for providing healthcare become blurred with economic prosperity. Originally, as 19th century Harvard University president Charles Elliot wrote, “the objective of research in medicine is to prevent industrial losses due to sickness and untimely death”. The impact that capitalism had on medicine was profound in transforming a profession based on caring for the ill to one driven by economic interests. This significantly altered the definition of health to reflect the motivations of healthcare to support other industries to sustain their profits.
Has healthcare became a commodity?
Work Environments are closely linked to health status:
The Marxist perspective furthermore claims that health is closely related to work environments such that unequal social structure should be considered more important to health issues than individual frailty or weakness. While this was largely evident during the rise of capitalism and the industrial revolution, such models reflect modern trends and the impact on health due to class division that modern capitalism causes. In the United Kingdom between 1991 and 1993 the incidence rate of lung cancer was almost five times greater in the unskilled population compared to the professional workforce. As the Marxist perspective explains, capitalism blurred the lines between providing healthcare and maintaining profit so that healthcare becomes related to one’s work environment and therefore social class.
Technology has increased medical capital and with that economic interests dominate:
The rapid evolution of medical knowledge and technology has led to a significant increase in medical capital, obscuring the motivations of administrators in providing healthcare to make profit. From the earliest days of healthcare, physicians could do little more than provide comfort for suffering patients. With little medical infrastructure, small public hospitals which serviced the poor, and charity supported private hospitals provided relatively indiscriminative medical care. Marxist theory explains that with insignificant amounts of money being spent on healthcare at the turn of the century, the business of medicine was not economically lucrative. Because of the lack of infrastructure and investment in medicine, healthcare, although relatively poor at this stage was not socially divisive.
Towards the middle part of the twentieth century an acceleration in medical knowledge and technology saw a rapid increase in medical capital:
By the early 1980s 6.3% of GDP was being spent on healthcare at a cost of $10.8 billion. In Australia today, this has grown to over 9% with over $120 billion being injected into healthcare. With an increasing amount of finance within the medical industry Marxist theory explains that a once charitable and service orientated profession is now shaped by an entrepreneurial mentality. Medical administrators and corporate directors gain unchallenged power which they use to exploit the medical market for further profit. In this situation healthcare becomes a socially divisive service, even in an Australian setting where the public system is not discriminative to who is provided with healthcare, however, healthcare quality still varies amongst social classes. Wealthier citizens who can afford private healthcare have greater control of hospital and doctor choice and have minimal waiting times for elective surgeries. Furthermore, however, there is an argument that with massive amounts of profit flowing to medical practitioners and hospitals, a growing patient distrust has emerged since doctors are now tainted by capitalism and money. While the quality of healthcare may be related to social class, the significant increase in medical capital has seen the definition of health, change universally among social classes to reflect the emerging capitalistic motivations for providing healthcare.
A Medical-Industrial Complex exists between the state and medical industry:
The Marxist model contributes significantly to the explanation of a developing Medical-Industrial Complex where an intricate interplay between governments and the medical industry has a profound effect on the distribution of healthcare. In Australia and similarly in all capitalist countries, both the private and public systems contribute to establishing an entrepreneurial approach to providing healthcare since the state funds in part both systems. All medical equipment and pharmaceuticals are bought by the state from large medical supply and pharmaceutical corporations, therefore contributing to the super profits of these companies. With ever growing profits brings greater power to such corporations who in turn use such to exploit the medical system to gain monopolistic control over this market sector and thus minimizing competition.
Taking patents on all newly developed technologies or drugs eliminates competition and establishes a market monopoly for that product:
This currently occurs through the research and production of drugs to the point that pharmaceutical companies have abandoned the manufacture of certain essential drugs on the basis that they’re not profitable. The American Society of Health Pharmacists (ASHP) reports a critical shortage of a drug called Fluorouracil which treats a variety of cancers.The ASHP attributes this to the fact that manufacturers have simply ceased its production due to its lack of profitability. Drug companies would rather focus their investment on, for example blood pressure drugs which a patient would need to take on a daily basis.
Political motives become increasingly self-interested with a growing medical economy:
With patients forced to spend substantial amounts of money on additional treatments a socially divisive element is introduced where their ability to afford such is determined by their social position. In Australia both state and federal governments have politicized medicine and the healthcare system in return for short term political gain, subsequently altering the medical landscape. With overwhelming and increasing investment in treatment, rather than prevention of illness, governments are able to maintain short term satisfaction with voters. Governments are hardly prepared to make sizable investment in preventative programs which the effects, if even noticed at all, would arise well after their term in government. Since lower social classes experience the greatest susceptibility to disease and illness the lack of preventative measures furthermore makes this a socially divisive issue. A medical – industrial complex contributes significantly to the degradation of the idea of health, as motivations alter.
Consequently, the idea of a medical-industrial complex where the state contributes to the monopolistic tendencies of medical companies exemplifies the Marxist claim that just because medicine is organized as a national system of healthcare it is not necessarily free from capitalist influence.
The effects of capitalism are profound on how we define health and contributes significantly to the evolving motivations for practicing medicine:
In our highly commercialized society medicine has become yet another commodity exploited by large corporations for profit. Because of the economically lucrative nature of medicine, providing healthcare has become a socially divisive yet fundamental need. With increasing medical capital and a developing Medical-Industrial Complex, Marxist theory provides a critique on the exploitative nature of capitalism and its effects on the evolving motivations for providing healthcare for profit.