Article Summary by Dr. John Mulligan
Using MD Anderson Cancer Center as a case study in nonprofit corporate medicine, this paper historicizes certain artificial constraints on debates over the role of healthcare corporations in American medicine, explores the consequences of these constraints, and suggests some ways of thinking about how we might begin to unwind them. Public discourse currently seems to be trapped in debates over what and even who medicine is for, and we argue that large hospitals, properly conceived, offer rich ground for rethinking the parameters of those debates—indeed that they have played this role for some time.
Our primary target is therefore uncritical economistic thinking, which squeezes out emergent, alternative values by attempting to optimize legacy measures of institutional health. This problem is particularly acute in the context of a neoliberal healthcare regime, under which matters of life and death, health and illness, are reduced to profit/loss ratios. Even within healthcare nonprofits the pressure to “become business-like” can hurry institutions into neoliberal quantification, as when patient quality of care is transformed into consumer satisfaction.
But our secondary target is no less important: the uncritical bias we sometimes find, towards reducing all things “corporate” to a neoliberal ideology. This conflation abets austerity’s social and psychic disinvestment from existing infrastructure. When we uncritically critique corporations as neoliberal, we both give up on any opportunity to reform or even use them, and we forget that they were, in the twentieth century, understood as privileged sites for buffering emergent forms of life from economic determination.
We hope our paper is useful in introducing some readers to some alternative values and cultures embedded in the large hospitals that we call corporate. In our readings of oral history interviews from the MD Anderson archive alongside historical debates over the corporatization of American medicine, we recuperate the apparently neoliberal discourses of “corporate medicine” and “physician leadership,” showing that these were and are sites of intense struggle over what and whom medicine is for, and why we should support it. We believe that such recuperations are important in our current moment, when healthcare is at some times portrayed as a privilege, and at others its universal guarantee is portrayed as an imposition.
The picture that emerges in this archive is one of the “exemplary but exceptional” profession at odds with itself within an exemplary but exceptional institution. But the problems we diagnose do not stem from these internal tensions, which can be healthy, but rather from their false resolution through wishful appeals to single measures of value such as cost, margin, or even the cruelly optimistic promise of a cure. The tensions that are made manifest in large hospitals such as Anderson can be treated as signs of a healthy working-out of the many demands we place on the medical profession, and as occasions for critical, open dialogue on the purpose and utility of institutional medicine—dialogue that the medical humanities should play a central role in.
Read the article at the Medical Humanities journal website.