Human Oriented? Angels and Monsters in China's Health-Care Reform

This article examines yihuan guanxi, or relations between medical professionals and patients, under China's health-care reform. Invoking "biopolitics" as a way of understanding the capillary workings of power in producing specific forms of lives and humans, I explore the ways in which different kinds of humans and tenuous claims to humanness are produced through the entanglement of government policy, market experimentation, and subject formation. Beginning in the mid-1990s, China's socialist health-care system has been rapidly transformed into a set of highly marketized practices, institutions, products, and subjects. In recent years, even though the emphatically "human-oriented" reform targets an emerging and heterogeneous middle-income citizenry as its primary subject and beneficiary, in everyday clinical encounters patients are confronted with rising health-care costs, inefficiencies, and even unethical practices. Medical professionals meanwhile have come to bear the brunt of patients' frustration. No longer praised as the self-sacrificing "angels" and "heroes" of the socialist health-care system, medical professionals are often portrayed in popular discourses as "monsters in white coats" that epitomize the wrongs of the market and the failures of the reform. This article, however, complicates such bifurcating representations of patients and doctors. Drawing on ethnographic and archival research, I suggest that, instead of pitched against each other from the opposite ends of the spectrum of humanity, medical practitioners and patients alike strive after state-promoted middle-class dreams. Yet, marginalized in the human-oriented health-care policy, the aspirations of medical professionals remain precarious and highly contested. Rather than wedged between patients and doctors, then, the friction in yihuan guanxi is produced from within situated discourses of the human and thus must be understood within shifting understandings and practices of humanness.