The Great U.S. Health Care Tension

Adam D. Reich's new book, Selling Our Souls: The Commodification of Hospital Care in the United States, is one of the best descriptions/explanations I've read of the tension between moneymaking and altruism in America's hugely complicated health care sector. For that matter, it speaks to the tension between the drive for profit and the drive to do good that characterizes U.S. society in general. The life-and-death aspects of health care intensify this tension and the contradictions that go with it.

America, more than any other great country, hosts a confusing mix of materialism and spirituality. Great greed (or just trying to make a living) and great charity.

Mr. Reich, a sociologist at Columbia, looks at the histories and current status of three very different California hospitals -- one devoted to the needs of the poor, another with a Catholic mission (but tending to market itself to affluent individuals) and a third with a managed-care, population-health emphasis (wave of the future?). He uses reporting on these institutions to look at the vivid paradoxes, hypocrisies, heroism and hopes of our health care ''system,'' with its huge disparities of access and practice. Mr. Reich analyzes how they respond differently to economic, regulatory, political and other pressures over the years.

He sums up his findings thus:

The "lesson of this book is that markets do not inevitably eviscerate our social values or inexorably lead to disorganization and chaos; but neither do we easily reconcile our values with markets or bring markets under control.''

This observation would apply to much of American society.

Robert Whitcomb (rwhitcomb51@gmail.com) is a Providence-based editor and writer, a Fellow of the Pell Center for International Relations and Public Policy (http://www.salve.edu) and a partner in Cambridge Management Group (www.cmg625.com), a health care-sector consultancy.