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Fees This article, on the fees associated with hospitals is in essence to be a meditation on what it means to pay for health care and a general look at some of the questions about health care that circulate at the moment. When we think of fees we think of a more abstract concept of doctor fees and hospital costs, the price of a hospital bed or an ambulance ride between hospitals. To be sure, doctors, like lawyers have commanded a fee and in the nature of that fee has been one of the grounds of their profession. Grounds here is a particularly chosen metaphor as fee once referred to land itself in an historical, legal sense of the term dating back to feudal times where the land being held was on the condition of feudal service. Now, while hospital beds are hardly serfs quarters, there is a definite relation between property, class and profession that are all embodied in hospital fees. The body in a sense here becomes property where the fee is the body you are but now in the service of a medical cultural establishment that ensure the conditions of its survival and the necessary actions to ensure that.
To a degree this can be called a cultural construct; however, some could perhaps legitimately argue that it is difficult to call the necessary conditions for healing or understand diseases to be cultural when they are functional regardless of cultural perspective. I think that one potential rebuttal of such a point is not deny that there are some to a degree basic necessities of life, truths about the essence of the way in which a virus or bacterium functions, but rather that the discourse of power that surrounds the way in which that knowledge is constructed taught and applied is in its very essence as cultural as it is scientific, the two being essentially the same thing. Is this not then a departure from a discussion of fees? Fees, in a more political though uncontentious, as it is not the goal of this article to be contentious as it is essentially meditative, manner are a thing of much heated debate in present day media. In the United States there is an ever present dialogue surrounding health care, access to health care and whether or not the fees that those with insurance find manageable are reasonable for those without insurance. These are, of course, very complex questions that individuals on both sides of the present day political divide will be and are very concerned about. Ultimately, however, I think that it is to a degree becoming necessary to take the issue of fees quite seriously and that there must on some level be a form of solution to what are undoubtedly present day problems regarding the cost of health care for some.
There is, obviously, no complete solution to any of the political and humanistic concerns regarding health care in the present day, but with continued debate and political reform of some sort it seems unlikely that questions about medical fees can be entirely ignored and indeed may continue to be hot button issues for those involved in policy and industry with regard to health care for some time to come. To return to fees in an abstract sense we might consider what is involved in paying the fees of a surgeon or a doctor or so forth. When one pays fees one is quite literally paying into a very large and old establishment and structures of power and knowledge. The fees in question are a mobile means of transforming the abstractions of money and knowledge into the realities of the body and the material conditions for living. In a sense, when we pay for the services of a doctor as much as we are purchasing someone else’s knowledge, we are purchasing ourselves, our material self. If the material sense of purchasing is always caught up technology and production, the production of the material of medical science and the pharmaceuticals, the fake hips, the walkers and so forth, then we are purchasing a reification of the collapse of the natural and the scientific or the natural and the technological. It is our interaction, through the payment of the doctor’s fees, the concretion of abstract labour and knowledge into the body that we purchase ourselves out of an illusion of nature and into the illusion of technology, but in reality we gain purchase by cohering the sense of the body’s fee, the abstract essence of the self’s maintenance, as a natural-technological-cultural essence. In maintaining our self, the purchase we gain is not just the grounding for life but a place, a role within complex schema of production, power and knowledge of which the fee itself is merely the means of grounding, the exertion towards self-redefinition.
Ultimately, what also lies behind the idea of the fee, the monetary relation between labour and knowledge, is perhaps a romantic understanding of the self as existing as in a sense natural and one that is corrupted by labour or technologies of the body. This perception is one that is flawed as it takes to a mistake political level the conception of the role of monetary exchange in doctor’s fees or hospital fees as reifying the corruption of the natural self. What I have tried to suggest in this meditation on fees in the hospital or medical concept is that the very nature of medical fees is not a Christian conception of man’s actions corrupting the natural self, but rather that it allows one to rehabilitate the self as able to understand the self as a cultural product – that nature and culture and just the same as technology – that all of these conceptions are cultural at root and that there is no essential natural self nor an essentially corrupting technology of medicine or alienation of the self through the abstract monetary exchange of fees. Fees, of course, are not entirely abstract in the sense that one must work to pay them and as such some may in a concluding thought wish to consider the way in which higher fees and the requirement of paying them reinforce larger social and economic structures around labour and the necessity of work.