Whatever the merits of capitalizing health, it is difficult to contest that the moral content of such a vision is extremely far from the classical virtues the healer should practice.

Not Medicare! Medicare is one of the worst of the entitlement programs in terms of cost. It gives far more than it takes in, and most watchers project a ruinous increase in the cost of Medicare as time goes on. The best approach would have to settle with the lobbies of the aged (old folks vote more per capita than others) and come to some means-tested approach where the deductible rises with income.

“Among the earliest promoters of HSAs were John Goodman of the National Center for Policy Analysis, a Dallas think tank that was instrumental in pushing President Bush’s Social Security privatization plan, and J. Patrick Rooney, a libertarian insurance executive who had promoted a school voucher program in his hometown of Indianapolis.”

With Eric J. Cassell in The Nature of Suffering and the Goals of Medicine (2nd ed., 2004), we need to think deeply about what it means to arrive at the conclusion that “The medical act has become a commodity to be bought and sold in a highly competitive managed care marketplace.”

Cassell elaborates on the particularly disturbing features of this commodification:

“It is safe to say that at the beginning of the twenty-first century financial and economic considerations have become *the* dominant (ahead of technology and medical science) forces shaping the nature of medical practice, and their influence increasingly permeates every aspect of medicine, including research, medical education, the lives of physicians, and the physician-patient relationship. In fact, as Kenneth Ludmerer has documented so persuasively [in Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care, 1999], monetary values had begun to displace humanitarian values throughout medical education by the final third of the twentieth century. In American medical education at this time financial concerns have overwhelmed virtually everything else. The same is true of the hospitals of the United States [cf. Guenter B. Risse, Mending Bodies, Serving Souls: A History of Hospitals, 1999].

Is this what Nietszche meant by the “transvaluation of all values”?

It is worth reminding ourselves that medicine is fundamentally a moral enterprise devoted to the relief of suffering as part of its general commitment to the health and well-being of persons. And it is this moral enterprise that needs to provide us with the fundamental bearings necessary to assessing the interconnected roles of economics, science and technology among the myriad means employed to meet the ends of health and well-being.