Healthcare As a Commodity
The United States is the world’s wealthiest country by GDP and yet its healthcare system significantly lags behind other wealthy nations. In a survey funded by the Commonwealth Fund in 2014, 39% of people surveyed in the U.S. reported that they did not go to the doctor despite having a medical problem because of cost, compared with 7% in Norway and Canada, 5% in Sweden, and just 1% in the UK (Christiansen 85). This is in part due to the privatized nature of healthcare provision which encourages excessive medication, testing, and procedures while simultaneously serving the interests of the pharmaceutical industry. The dire state of healthcare in America begs the question of whether healthcare should be treated as a product that can be bought and sold. In other words, should healthcare be commodified? Inferring from the criteria for commodification put forth in Chapter 4 of Michael Walzer’s Spheres of Justice, healthcare is a good that is useful to all members of a community, and is thus considered an essential good and should be provisioned communally. Additionally, healthcare lacks elements to be commodious and fetishized and therefore disqualifies as a commodity. For these reasons, individuals should be entitled to healthcare and we should terminate its current form of commodification.
Walzer’s criteria for justifying commodification focuses on the good’s communal provision and unique value to individuals. He writes in the “Money and Commodities” chapter that “all those objects, commodities, products, services, beyond what is communally provided, that individual men and women find useful or pleasing” such as “luxuries …staples, goods that are beautiful as well as goods that are functional and durable” qualify for commodification(Walzer 103–4). When a good or service is provisioned communally, it implies that it is essential to the entire community. A city’s water supply and police force are good examples of this. But beyond these communal goods, no one is entitled to anything else because other goods and services provide varying degrees of comfort or utility to each person. A shovel, for instance, may be a good that is useful to you but not to others in the neighborhood because only you like gardening. It follows that such goods and services are nonessential and can be commodified. A commodity also has unique attributes. The first is fetishization. Commodities can be manipulated to have meanings beyond their actual value by cultivating desire (most commonly through advertising) and even generating fetishes for the product. The next is membership. Oftentimes, one’s ownership of a commodity can be a way to indicate social status or membership in some exclusive group. If a good exhibits occurrences of being fetishized or used to buy a membership in some group, then it can be labeled as a commodity.
Adding to his straightforward criteria based on want and need, Walzer rules out a list of things that would damage basic rights, freedoms, and the well-functioning of our society if they were commodified. His exhaustive list includes human beings, human rights and freedoms, political power and office, criminal justice and activity, basic welfare services, and divine grace (Walzer 100–3). These criteria are sound because they protect basic goods from being exploited under capitalism and create an ethical standard for evaluating things for commodification. Ultimately, Walzer would allow a good or service to be commodified if it is nonessential, and commercializing it would not harm human rights, freedoms, and social structures.
Since having a healthy body and mind empowers us to perform the things that make us human, such as work, leisure, and politics, healthcare is said to be essential to human beings. But by putting a price tag on our health (i.e. commodifying it), a transactional element is involved. While Walzer does not directly address the justifiability of commodifying healthcare, we can deduce from his criterion prohibiting the exchange of human beings that it is unjust. First, we must evaluate the relationship between human health and function before relating it to healthcare. At the core, our physical and mental health is what allows us to socialize, work, think, participate in government, and do everything that makes us uniquely human. When we become sick, say, with a fever, we are often immobilized in bed, taking care of our bodies and focusing on recovery. Our life is put on hold temporarily for the time we are sick. While we are still obviously “human” on the exterior, the state of being sick is comparable to the vegetative state in plants. This is exemplified by more severe cases of sickness, such as coma or cancer treatments that require a patient to be hospitalized for extended periods. In such scenarios, the patient has certainly lost their human function and their life is diminished to mere survival. Healthcare’s role, then, would be to prevent such cases of sickness and ensure human function. However, if the nature of commodification is that its provision is based on how much money one offers for it and not how much one needs it, then evidently the commodification of healthcare will leave many sick patients without the medical attention they need as it is not a desert but a monetary-based system. It follows that if the health and lives of patients are monetized, then there exists a transactional relationship between the healthcare provider and its patients. This form of commodification of human beings, as Walzer rules out, is unjust.
The Enrollment and Conscription Act of 1863 in the U.S. raised by Walzer is an example that closely mirrors the monetization of human beings in healthcare. During the Civil War, large armies had to be assembled on an unprecedented scale, so a national draft was passed but with exemptions that could be purchased for three hundred dollars. Not surprisingly, this policy received much backlash since only rich people could escape the draft, causing many to reiterate the opinion that poor men should not have to give up their lives. When a price is assigned to exempt someone from fighting, a price is simultaneously assigned to their freedom. The government, then, is effectively commodifying the freedom of men, who are reduced to slaves without it fighting and risking their lives for the government. While the healthcare system does not turn its patients into slaves, it is the problematic aspect of putting a price tag on human life and freedom that is shared in both examples. This, when evaluated against Walzer’s criterion, would be unjustified.
The nature of healthcare is incompatible with that of a commodity because it is not commodious, cannot be purchased to gain status or membership, and is impossible to become fetishized. Therefore, healthcare should not be commodified because it is not a commodity in the first place. A key criterion identified by Walzer for the commodification of goods and services is that they are “commodious…a source of comfort, warmth, and security”(Walzer 104). Commodities, by nature, provide feelings and uses that essential goods and services cannot. The comparison between water and tea is a good example. Water is something essential that we need to survive. We enjoy water to the extent that it quenches our thirst and keeps our bodies healthy; it merely provides subsistence. Tea, on the other hand, is a good that people enjoy in the proper sense. Drinking tea can be therapeutic for many illnesses. It gives people warmth and a sense of security and comfort insofar as routines and habits are concerned. The rich, long-standing tradition and history surrounding tea is also something that many around the world cherish. Therefore, the unique feeling, comfort, and cultural value that comes with drinking tea qualify it as a commodity. Similar to water, healthcare is a service that provides subsistence by keeping our bodies healthy. There is nothing fundamental about healthcare that we can, in the proper sense, cherish and enjoy. A person may find it comforting to have good health, but this comfort is trivial compared to how tea is comforting because it is simply a human need. For someone to gain pleasure and comfort in the proper sense, buying commodities is one way to achieve that because they provide unique value and meaning that is not found in essential goods, which provide the same value to everyone.
Healthcare’s nature as a human need renders it impossible to give social status or membership to a person like how a commodity can. According to Walzer, commodities mediate membership and are sometimes required for someone to own to be recognized socially (Walzer 105–6). An example of this could be a luxury watch or car that someone owns to indicate their elite status or membership in some elite class of people. If this commodity is missing, that person risks being stripped of their status by members of the group. Having healthcare or good health, on the other hand, does not come with any social status (other than the obvious label that one is healthy), nor is it required by any group for membership. Healthcare also fails the fetishism criterion for the same reason that it is essential to us; there is a ceiling to what good healthcare can be, which is comprehensive, preventative, and quality medical care. Regardless of how much one corrupts the meaning of healthcare, its intrinsic value remains the same. It would be unusual, for example, for a healthcare provider to advertise that their services can prolong a person’s life by ten years, or make someone physically superior to everyone. Whereas for a commodity, it is normal to exaggerate its importance or perceived value because there is no ceiling to what kind of value and importance a commodity could provide for the consumer. A BMW sedan, in essence, has the same function as that of a Toyota Prius, but the “symbol of belonging” and “identity” that comes with owning a BMW are more fashionable and desirable than a Toyota(Walzer 106). Perhaps owning the BMW can get you that hot date you have always wanted, or make you the most popular kid at school. These attached values are, of course, manufactured through advertisement and elevated by imagination, and ultimately can only be ascribed to commodities.
A pro-commodification position could argue that healthcare is, in fact, commodious in the sense that it gives people security and comfort in knowing that they are healthy and can receive the care they need if they were sick; therefore, it should be commodified. While this contention has its merits, it misinterprets the kind of comfort that essential goods provide. Since a commodity provides comfort on the basis that an individual’s low-level comforts are satisfied by essential goods, the types of “comfort” that an essential good and commodity provide are different. Once again, the relationship between human need and human want needs to be examined. Our demand for essential goods always comes before commodities. For instance, when one is sick, they do not seek, say, the flower vase they have been eyeing all week but the correct medicine they need to recover to full health. It is after they have regained their health that they can then desire the flower vase that could please them. From this example, it is clear that the “comfort” that something essential like medicine brings us is different from the “comfort” that a commodity like a vase brings us because the latter’s provision is contingent on the first. While the flower vase may give us comfort and pleasure from, say, how beautiful it looks or the pretty flowers it can hold, we cannot enjoy it and feel the comfort it brings unless we are well enough to perceive the flower vase and enjoy its features to begin with. Therefore, the comfort provided by essential goods is more of a necessity or requirement than something we simply desire to have. Our objects of desire are never so strong that we have to, by any means necessary, fulfill them, which would then just be called a need. Essential goods, then, do not make us commodious but rather make us subsistent, which is comfortable in itself but not to the full degree that commodities provide.
In conclusion, Walzer’s criteria for justifying the commodification of goods is sound because it not only prevents basic goods from being exploited under capitalism but also creates an ethical standard for commodification. When using it as a guide to evaluating healthcare’s commodified nature, it is clear that healthcare is an essential good that cannot be fetishized or used as an indicator of membership. Further, while it is comforting for someone to have healthcare, it does not qualify as commodious in the same sense as commodities do. For these reasons, healthcare disqualifies as a commodity and should not be commercialized.
