"No place to be sick": Cooptation and convergence in the US hospital care sector

This paper tries to answer the question: in what ways does the logic of capital accumulation shape the organization of hospital care in the US - a sector characterized by a preponderance of both public and private "not-for-profit" institutions? Rather than taking different hospital ownership types as our analytical starting point, to answer this question, we approach the dynamics of the sector as a struggle between "capitalized care" and organized resistance to it. Taking inspiration from the capital as power political economic approach, we define "capitalized care" as a system of health care in which care is subordinated to the ongoing accumulation of power and profit. We map our investigation of organized power onto four empirical dimensions, focusing on the years 2011-2021: organized resistance to capitalized care; distribution of hospitals by ownership type; relative size and concentration of hospital systems; and relative inflation of price markups. We find that these dimensions are closely connected, suggesting that the hospital sector at large is deeply caught up in the logic of capital accumulation. While marginal, organized resistance to capitalized care continues to shape the other dimensions of the hospital landscape - namely, the balance of power between for-profit (FP) and not-for-profit (NFP) hospital systems, the profitability and concentration of large hospital systems, price inflation and medical debt. Not just FP hospitals, but also public and NFP hospitals have become tightly integrated into an overall logic of capitalist accumulation within the sector, leading to increasing consolidation, price inflation, health care inequality, and paradoxically, a large and growing public cost of healthcare.