Are Commercial Sex and Health Care Commodities?

Former New York governor, Spitzer, purchase sexual services to meet his needs. From the available reports, he treated sex as a high-priced commodity, to be obtained as and when he wanted it, from relatively anonymous sources. There are some parallels with health care which is increasingly being treated as a commodity, available from commercial sources through relatively anonymous providers.

Brief encounters with physicians who have no previous meaningful experience with their patients and who does not expect to encounter these patients again, represents poor health care. Despite the current hype, no electronic medical record can replace the nuanced interaction between patient and physician (or other health care provider) which profoundly affects the care given for that event and future events. The paper or electronic record, no matter how complete, is a dry recitation of a limited number of facts - a current complaint, history, drug allergies, physical findings, laboratory tests, diagnosis and treatment plan. It does not evoke the expression on the patient's face as she describes problems at home, does not describe a daughter's interest in having her mother continue to drive her children home from school, notwithstanding mother's progressive dementia, or detail the brief encounter's actual conversation between physician and patient.

When health insurance was a side-line business, undertaken so that the insurer could do more important and lucrative business with employers, physicians rendered "usual and customary" care and were paid for it. The payers paid, and physicians rendered care. In the early 1980s, interest rates skyrocketed and insurers suddenly discovered that they could take advantage of the float on their accounts payable. And suddenly, a commercial revolution in health insurance occurred. Then HMOs appeared, facilitated by President Nixon's legislation fostering their development. Initially the HMOs were non-profit, with community rates, and provided appropriate care while, with physicians and other health care providers, they explored methods of providing more efficient care. But the dollar flow and profits to be made led to conversion of almost every not-for-profit HMO into a for-profit operation. The service that the HMOs provided was not high quality health care: it was system development, which meant that they provided an easy way for employers to purchase health insurance, development of networks of physicians, hospitals and other providers, and the generation of substantial profits. PPOs, the next stage in health care insurance coverage, tagged on after HMOs, enjoying the benefits of the more efficient services physicians and others were providing without paying the development costs. Health care became a commodity and ownership of a network of providers became a valued asset which allowed enterprises to generate enormous capitalized values. The relationship between patient and his or her provider became almost irrelevant: the employer would choose one insurer, HMO or PPO one year and leave it and its network of providers for another the next year. Health care became an almost anonymous uninformed commercial transaction. Which brings us back to Mr. Spitzer and raises the question why the public isn't as outraged about the health care it receives as it is about his conduct?