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When Worlds Collide: Medicine, Business, the Affordable Care Act and the Future of Health Care in the U.S.

Published online by Cambridge University Press:  01 January 2021

Extract

Many observers claim that business has become a powerful force in medicine and that the future of health care cannot escape that reality, even though some scholars lament it. The U.S. recently experienced the most devastating recession since the Great Depression. As health care costs rise, we face additional pressure to rein in health care spending. We also have important new legislation that could well mark a significant shift in how health care is provided and who has access to care, namely the Affordable Care Act (ACA). These changes underscore the need to bring new thinking to the conversation about health care and to move beyond conceptual and practical obstacles that inhibit our progress.

In this paper we do not to claim to have solutions. Rather, our aim is to try to identify some obstacles to fostering a better conversation about the future of health care and to envisioning a better health care system.

Type
Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2014

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References

Churchill, L. R., “The Hegemony of Money: Commercialism and Professionalism in American Medicine,” Cambridge Quarterly of Healthcare Ethics, no. 16 (2007): 407414.Fins, J., “Commercialism in the Clinic: Finding Balance in Medical Professionalism,” Cambridge Quarterly of Healthcare Ethics, no. 16 (2007): 425–432.Burns, L., “The Business of Healthcare Innovation in the Wharton School Curriculum,” in Burns, L., ed., The Business of Healthcare Innovation (Cambridge, UK: Cambridge University Press, 2002): At 1–36.Timmermans, S. Hyeyoung, O., “The Continued Social Transformation of the Medical Profession,” Journal of Health and Social Behavior (51, no. 5. (2010): S94–S106.Brody, H., “Medicine's Ethical Responsibility for Health Care Reform – The Top Five List,” New England Journal of Medicine, no. 362 (2010): 283–285.Starr, P.: Remedy and Reaction (New Haven, CT: Yale University Press, 2013).Gibson, R. Singh, J. P., Medicare Meltdown: How Wall Street and Washington are Ruining Medicare and How to Fix It (Latham, MD: Rowman & Littlefield, 2013).CrossRefGoogle Scholar
For example, Churchill, , supra note 1;Fins, , supra note 1;Medicare Meltdown, supra note 1;Remedy and Reaction, supra note 1.Google Scholar
These arguments were originally articulated in Wicks, A., “Albert Schweitzer or Ivan Boesky? Why We Should Reject the Dichotomy between Medicine and Business,” Journal of Business Ethics, no. 14 (1995): 339351, at 341–342.CrossRefGoogle Scholar
Harrison, J. Wicks, A. C., “Stakeholder Theory, Value, and Firm Performance,” Business Ethics Quarterly 23, no. 1 (2013): 97123.CrossRefGoogle Scholar
Smith, A., The Wealth of Nations (New York: Simon and Brown, 2014).Google Scholar
See Harrison, Wicks, , supra note 4, at 97.Google Scholar
Andereck, W., “From Patient to Consumer in the Medical Marketplace,” Cambridge Quarterly of Healthcare Ethics, no. 16 (2007): 109113.CrossRefGoogle Scholar
Churchill, L. R., “The Hegemony of Money: Commercialism and Professionalism in American Medicine,” Cambridge Quarterly of Healthcare Ethics, no. 16 (2007): 407–14.CrossRefGoogle Scholar
See Andereck, , supra note 9, at 109.Google Scholar
See Churchill, , supra note 10, at 411.Google Scholar
See Fins, , supra note 1, at 429.Google Scholar
Gilmartin, M. Freeman, R., “Business Ethics and Health Care: A Stakeholder Perspective,” Health Care Management Review 27, no. 2 (2002): 5265.CrossRefGoogle Scholar
Id., at 52.Google Scholar
Id., at 52.Google Scholar
Freeman, R. Harrison, J. Wicks, A. Parmar, B. de Colle, S., Stakeholder Theory: The State of the Art (Cambridge: Cambridge University Press, 2010);see Gilmartin, Freeman, , supra note 14.CrossRefGoogle Scholar
Haidt, J., The Righteous Mind: Why Good People Are Divided by Politics and Religion (New York: Vintage, 2013);id. (Stakeholder Theory).Google Scholar
Wicks, A., “The Business Ethics Movement: Where are We Headed and What Can We Learn from Our Colleagues in Bioethics?” Business Ethics Quarterly 5, no. 3 (1995): 603–20;Wicks, , supra note 3.CrossRefGoogle Scholar
Freeman, R., Strategic Management: A Stakeholder Approach (Boston: Pitman, 1984).Google Scholar
Freeman, R., “The Politics of Stakeholder Theory: Some Future Directions,” Business Ethics Quarterly, no. 4 (1994): 409421.CrossRefGoogle Scholar
Solomon, R., Ethics and Excellence (Oxford: Oxford University Press, 1993).Google Scholar
Friedman, M., “The Social Responsibility of Business Is to Increase Its Profits,” New York Times Magazine (September 13, 1970): 3233, 122–124.Google Scholar
See Freeman, , supra note 21.Google Scholar
Nelson, J., Economics for Humans (Chicago: University of Chicago Press, 2006).CrossRefGoogle Scholar
Frank, R., Passions within Reason: The Strategic Role of the Emotions (New York: W.W. Norton & Co., 1986).Google Scholar
Mackey, J. Sisodia, R., Conscious Capitalism: Liberating the Heroic Spirit of Business (Cambridge, MA: Harvard Business Review Press, 2013).Google Scholar
Mackey, J., “Conscious Capitalism: Creating a New Paradigm for Business,” FlowIdealism.org (2007), available at <http://www.flowidealism.org/2007/Downloads/Conscious-Capitalism_JM.pdf>(last visited June 2, 2014).(last+visited+June+2,+2014).>Google Scholar
Collins, J. Porras, J., Built to Last: Successful Habits of Visionary Companies (New York: Harper Business, 1994).Google Scholar
Hansen, K., “Merck and Co., Inc. (A)” (Cambridge, MA: Harvard Business Publishing, 1991), available at <http://hbr.org/product/merck-co-inc-addressing-third-world-needs-a/an/991021-PDF-ENG>(last visited June 2, 2014).Google Scholar
See Built to Last, supra note 30, at 16.Google Scholar
For a thorough discussion of systems thinking in business ethics, see P. Werhane, “Moral Imagination and Systems Thinking,” Journal of Business Ethics 38, nos. 1–2 (2002): 3342.CrossRefGoogle Scholar
See Rawls, J., A Theory of Justice (Cambridge: Belknap/Harvard University Press, 1971).Google Scholar
See Kinney, E., “For Profit Enterprise in Health Care: Can It Contribute to Health Reform?” American Journal of Law & Medicine 36, nos. 2&3 (405–35): 405–435, at 418.CrossRefGoogle Scholar
Id., at 418, 424.Google Scholar
See Moses, H. Matheson, D. Dorsey, E. George, B. Sadoff, D. Yoshimura, S., “The Anatomy of Health Care in the United States,” JAMA 310, no. 18 (2013): 19471963, at 1961.CrossRefGoogle Scholar
Porter, M. Tiesberg, E., “How Physicians Can Change the Future of Health Care,” JAMA 297, no. 10 (2007): 1103–11.CrossRefGoogle Scholar
See Relman, A., “What Market Values Are Doing to Medicine,” Atlantic Monthly (March 1992), at 106.Google Scholar
Ruger, T., “Can a Patient-Centered Ethos Be Other-Regarding? Ought It Be?” Wake Forest Law Review 45 (2010): 15131523. Ruger notes this tension and the difficulty of providing these benefits within the current system and hoping that they will be used responsibly.Google Scholar
Id., at 1521–22.Google Scholar
Id., at 1522.Google Scholar
Goodstein, J. Wicks, A., “Corporate and Stakeholder Responsibility: Making Business Ethics and Two-Way Conversation,” Business Ethics Quarterly 17, no. 3 (2007): 375398; Elms, H. Phillips, R., “Private Security Companies and Institutional Legitimacy: Corporate and Stakeholder Responsibility,” Business Ethics Quarterly 19, no. 3 (2009): 403–432.CrossRefGoogle Scholar
See Kinney, , supra note 35, at 418.Google Scholar
See Righteous Mind, supra note 18.Google Scholar
Milgram, S., Obedience to Authority (New York: Harper Collins, 1974).Google Scholar
Haney, C. Banks, W. Zimbardo, P., “Interpersonal Dynamics in a Simulated Prison,” International Journal of Criminology and Penology, no. 1 (1973): 6997.Google Scholar
Tax, S. Brown, S., “Recovering and Learning from Service Failure,” Sloan Management Review 40 (1998): 7588.Google Scholar
Woolhandler, S. Ariely, D. Himmelstein, D., “Why Pay for Performance May Be Incompatible with Quality Improvement,” BMJ 345 (2012): e5015.Glasziou, P. Buchan, H. Del Mar, C. Doust, J. Harris, M. Knight, R.et al, “When Financial Incentives Do More Good Than Harm: A Checklist,” BMJ 345 (2012): e5047.CrossRefGoogle Scholar
Id. (Woolhandler, et al).Google Scholar
Song, Y. Skinner, J. Bynum, J. Sutherland, J. Wennberg, J. Fisher, E., “Regional Variations in Diagnostic Practices,” New England Journal of Medicine 363 (2010): 4553.Welch, H. Sharp, S. Gottlieb, D. Skinner, J. Wennberg, J., “Geographic Variation in Diagnosis Frequency and Risk of Death among Medicare Beneficiaries,” JAMA 305 (2011): 1113>–1118.CrossRefGoogle Scholar
Green, A. Carney, D. Pallin, D. Ngo, L. Raymond, K. Iezzoni, L. Banaji, M., “Implicit Bias among Physicians and Its Prediction of Thrombolysis Decisions for Black and White Patients,” Journal of General Internal Medicine 22, no. 9 (2007): 12311238.CrossRefGoogle Scholar
See Woolhandler, et al, supra note 51.Welch, et al, supra note 53.Google Scholar
Fernandez-Dols, J. Aguilar, P. Campo, S. Vallacher, R. Janowsky, A. Rabbia, H. Brussino, S. Lerner, M., “Hypocrites or Maligned Cooperative Participants? Experimenter Induced Normative Conflict in Zero-Sum Situations,” Journal of Experimental Social Psychology 46, no. 3 (2010): 525530.CrossRefGoogle Scholar
See, for example, Hsieh, P., “How Obama Care Creates Ethical Conflicts for Physicians and How Patients Can Protect Themselves,” Forbes (January 28, 2014), available at <http://www.forbes.com/sites/paulhsieh/2014/01/28/how-obamacare-creates-ethical-conflicts-for-physicians/>(last visited June 2, 2014).(last+visited+June+2,+2014).>Google Scholar
Korenstein, D. Falk, R. Howell, E. Bishop, T. Keyhani, S., “Overuse of Health Care Services in the United States: An Understudied Problem,” Archives of Internal Medicine 172, no. 2 (2012): 171178.CrossRefGoogle Scholar
Angus, D. Barnato, A. Linde-Zwirble, W. Weissfeld, L. Watson, R. Rickert, T. Rubenfeld, G., “Use of Intensive Care at the End of Life in the United States: An Epidemiologic Study,” Critical Care Medicine 32, no. 3 (2004): 638–643.CrossRefGoogle Scholar