The Power and Limits of Political Philosophy in Analyzing Healthcare Markets

Bioethics is taking an institutional turn, where organizations are being taken seriously as moral agents. Within US healthcare, this is difficult to do without confronting "the market" as a highly influential context for organizational behavior. In the 1990s, pioneering thinkers such as David Mechanic,¹ Brad Gray, and Mark Schlesinger² undertook a first round of organizational ethics scholarship focused on how market forces influence health insurer behavior - motivated by a particular concern for health maintenance organizations (HMOs).³ And more recently, owing partly to a transfer of financial risk⁴ to healthcare delivery organizations,⁵ rapid consolidation within health system markets,⁶ and the pronounced uptick in physician employment,⁷ the behavior of healthcare delivery organizations is also being assessed in relation to market forces.