I had never heard of the Rashi Fein, who died last week, until today. Apparently, he developed ideas for Medicare legislation in the 1960s and criticized the nation’s inability to create a federal single-payer system for healthcare.
He was also a critic of the language of commodities (in a piece that appeared in 1982 in The New England Journal of Medicine):
A new language is infecting the culture of American medicine. It is the language of the marketplace, of the tradesman, and of the cost accountant. It is a language that depersonalizes both patients and physicians and describes medical care as just another commodity. It is a language that is dangerous. . .
In speaking the new language, doctors have adopted the attitudes and methodology of economics — a narrow economics that emphasizes efficiency more than equity. Everything is to be evaluated in terms of benefit-cost relations, and cynicism has become apparent in the discussion. . .
In no small measure, physician-administrators speak the language that they speak because they reflect the world in which they live and the system in which they function. If society wants them to use different words, it must create conditions that encourage them to do so. . .
A decent medical-care system that helps all the people cannot be built without the language of equity and care. If this language is permitted to die and is completely replaced by the language of efficiency and cost control, all of us — including physicians — will lose something precious.
I cannot guarantee that we will structure the system in a way that will emphasize compassion and human values. I do believe, however, that these values cannot be nurtured in a cultural soil in which patients are described as teaching material, a medical practice is described as a business, delivering medical care is described as producing a product, and human interactions are increasingly described in terms of financial transactions.