This nation’s sputtering, inept response to the coronavirus pandemic has sparked a mountain of self-analysis from academic and political observers of the health care policy world. Why were we so unprepared to deal with the virus when other nations responded both faster and more effectively?
The answer, I believe, is tightly linked to the other questions about the sad state of our health care that fill pages of space in journals and political platforms with debate, but that so far have produced little improvement in how our system functions. A few of those other questions are:
- Why do we spend twice as much per capita on health care as any other country in the world, yet have demonstrably poorer outcomes?
- Why do we have such a high percentage of our people who skip medical care because they have no way to pay?
- Why has our enormous national investment in high-tech health care and a dizzying array of pharmaceutical products left us with a decreasing life expectancy?
- Has shifting our budgetary emphasis to medical care from public health care actually decreased the quality of life for more Americans than it has helped?
Of course, coming up with answers to any of those questions would take multiple doctoral dissertations … or would it? I think there actually is a single, very simple answer to all those questions. We may not choose that answer because of political considerations, but our health care won’t get better until we do.
Our health system failure stems from our choice, evolving over 50 years, to shift from treating health care as a basic public service to looking at it as a business, a field for financial entrepreneurs, a fast way to make a buck. Foolishly, we are trusting greed to produce good health outcomes. Since it works for producing automobiles, computers and widgets, why not use capitalism to provide health care? Because it treats human life as just another factor of production.
The downfall of our system can be traced to 1985, the heart of the Reagan years. That’s when the century-long tension between medical care as service-driven and medical care as profit-driven collapsed completely and capitalism took over, unapologetically and with a vengeance.
Hospitals, HMOs and nursing homes became chains listed on the New York Stock Exchange. Big Pharma and Big Insurance grabbed sick Americans by the scruff of their necks and shook every available dollar out of their wallets. Bankruptcies from medical costs went through the roof.
It might have made sense if we actually saw some improvement in health as a result. But we haven’t. Because health care decisions are so crucial to families, they are totally at the mercy of this marketplace. There are no standards for billing, so there’s money to be made in billing for anything and everything. Prices rise to whatever the market will bear. Medical bankruptcies soar.
It may be a great way to make money, but it doesn’t save lives. We won’t actually produce good health care outcomes for everyone until we remove the profit motive from medicine. Profiting from human misery should not be our public policy. After decades of relying on Adam Smith’s thinking to improve health in the U.S., we spend more public and private dollars than ever and benefit less.
Capitalism isn’t evil; it just is what it is: a system to maximize profit. Auto manufacturers resisted safety features that would have saved lives in an effort at maximizing profit. Tobacco companies kill thousands in the rush to earn dividends. Pharmaceutical companies churn out deadly opiates to enhance their bottom line. And today, in a pandemic, businesses argue we should open up the country early — even if lives are lost in the process.
Simply put, we cannot afford to allow for-profit hospital chains, insurance companies and pharmaceutical giants to bleed America dry any longer. Health care should be a public service, not a line on a corporate profit and loss statement. The pandemic has demonstrated how ill-served we are by trying to jam medicine into a market model. Lives are at stake.