Is medicine a market commodity, like cosmetics? Or is it [different]—in ways that make commerce in health care crass, even indecent? Americans, it would seem, want it both ways. Since colonial times, Americans have both embraced and rebelled against commercialism in the health sphere. Market-driven change in the United States health system has varied in pace but never ceased. In the 1990s, it accelerated dramatically.
The failure of President Clinton's health reform plan in 1994 set off a surge of entrepreneurship. With the prospect of comprehensive legislation gone, insurers, doctors and hospitals, and health care purchasers were free to act without high political and regulatory risk. Motivated by soaring medical costs, they did so aggressively. Health care payers and providers forged novel business arrangements and organizational forms, aimed at controlling costs while meeting consumers' expectations. Employers shopped the medical marketplace energetically, searching for coverage that could enable them to compete for labor at manageable cost. Taking reform into their own hands, these actors remade the business of medicine. The health care system that emerged at the end of the 1990s bore little resemblance to what either market proponents or market skeptics had predicted a decade before.
This book considers the transformation the market has wrought. Its authors, for the most part, take American reliance upon the medical marketplace as a given: