The Financialization of Health in the United States

The most important health-care development of the day is the recent, relatively unheralded rise of a huge new industry that supplies health-care services for profit. Proprietary hospitals and nursing homes, diagnostic laboratories, home-care and emergency-room services, hemodialysis, and a wide variety of other services produced a gross income to this industry last year of about $35 billion to +40 billion. This new "medical-industrial complex" may be more efficient than its nonprofit competition, but it creates the problems of overuse and fragmentation of services, overemphasis on technology, and "cream-skimming," and it may also exercise undue influence on national health policy. In this medical market, physicians must act as discerning purchasing agents for their patients and therefore should have no conflicting financial interests. Closer attention from the public and the profession, and careful study, are necessary to ensure that the "medical-industrial complex" puts the interest of the public before those of its stockholders.

Increasing access to diverse types of credit and spreading indebtedness across many social groups were significant economic developments of the twentieth century and into the twenty-first, with implications for social inequality and insecurity. This review evaluates the role of credit and debt in social inequality in the United States. Credit and debt shape inequalities along multiple pathways, in defining social inclusion and exclusion, directing life chances, and facilitating oppression. On the basis of this review, I conclude that building on the progress made in prior research calls for a relational approach to understanding credit, debt, and inequality that includes a focus on the powerful actors that benefit from a political economy increasingly dependent on credit and debt to distribute, regulate, and control social resources. I close by identifying outstanding questions that need to be answered in order to move forward our understanding of economic inequality and insecurity, as well as for social policy and the prospects for collective action.