Selling Our Souls: The Commodification of Hospital Care in the United States. By Adam D. Reich Princeton, NJ: Princeton University Press, 2014. 248 pp. ISBN 978-0-6911-60405, $39.50
Reich’s main focus is on the institutional legacies that shape how the people working in his cases reconcile the contradictions between their non-economic values and market pressures. The former public hospital’s contradiction is between the scarcity of resources and the practice of providing extensive uncompensated care to underinsured and uninsured patients. The people in this hospital view care as a social right, and Reich interprets their disregard for efficiency and profitability as rebuffing market pressures. In the Catholic hospital, the contradiction is between the values of sacrifice and dignity, with which many in the hospital identify, and management’s marketing of these values to attract high-paying patients, the treatment of uninsured patients with little dignity, and the lowest wages for nurses and ancillary workers among the three cases studied. Reich interprets this case as moralizing market pressures. In the integrated health management organization, customized care according to each patient’s special needs contradicts the organization’s prevailing operating principle of standardizing and rationing care by scaling up efficient practices. Reich interprets this case as taming market pressures through the use of bureaucracy and big data. The author lays out these three types of moral–market relationships by examining the conception of care, the structure of physicians’ work, and the power and division of labor between physicians, nurses, and ancillary workers including the role of labor relations in each of the cases. Another interesting argument in the book is that these three different moral–market relationships correspond to three different historical periods. I find Reich’s well-grounded discussion and critique of the three models highly persuasive.
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