How U.S. Health Policy Embraced Markets and Helped Wall Street Gentrify Medicine

Abstract

Abstract This article examines the financial industry’s critical role in retargeting U.S. health policy goals of improving peoples’ health in the 1960s to those of expanding institutional wealth in the 1970s. Government collaborated with finance to support not-for-profit hospitals’ use of debt to build services that augmented capital and operated like for-profit businesses. Certificate of Need, hospital rate review, and national health planning programs came to assess hospital performance in terms of capital formation, returns on investment, and bond ratings. The regulatory programs helped gentrify medicine by reinforcing selective investment in lucrative, high-tech services that market specialty procedures to affluent populations in place of disease control, primary care, and general acute care for all. Their actions laid the groundwork for the 1980s finance industry coup, which employed market ideology to dominate health policy at the expense of equality, effectiveness, and public health governance.