Healthcare Episode
Why does it suck so much to get sick? Illness is part of human life-at some point, everyone plays host to an infectious disease, gets injured, or goes through some other ailment beyond their body’s ability to cope. So what do we do when another human being is sick? Do we leave the wounded in the back of the herd to fall victim to the next predator to come? No-even in the fossil record of prehistoric humanity, we see proof of how when we’re in need of care, other people in our community help take care of us. But in this modern Capitalist society, for all our advancement, technology and understanding, it seems we’re sicker than ever. There are people talking at length about making our society healthy “again”, but the way healthcare is done in the United States is itself a public health issue that these people will never even attempt to solve-and that is why I’ve brought on our first guest to write the script for this episode.
Hi, I’m J. I work as a public health professional in a major city, but my family’s experiences with the healthcare system in this country goes back much farther than that. My older brother was born with serious heart problems, and had to undergo his first surgery at only a few weeks old-the first of many he’s had to go through. I myself was diagnosed with cancer at 13, and between those two things my parents are still dealing with extensive debts. And our story isn’t an uncommon one-nearly 1 in 12 adults in the United States have some level of medical debt, and nearly half of all bankruptcies are due at least in part to medical debts. So what is the underlying issue? Why are so many people left financially crippled by the services designed ostensibly to heal them?
I’d like to introduce the idea of an “inelastic good”. This is a pretty orthodox economic term, with even Adam Smith discussing the concept. There are certain items: food, water, clothing, shelter-that every human being needs to survive. Healthcare certainly falls under this category-you either get it or you die. When a producer raises the price on one of these goods, say, in the case of food, there is no real falloff in demand-this is a key driver of famines, as people can’t exactly “opt out” of needing to eat. Therefore, in a capitalist market system, healthcare manufacturers and providers can and will maintain high prices knowing that their supply of customers is all but assured. Basic medical goods like insulin provide a ready example. Despite often costing less than $10 per dose to manufacture, insulin routinely is sold for multiple hundreds of dollars per dose. Companies will attempt to justify these insane costs by claiming they are necessary to fund further research and development. This is an absurd claim for a number of reasons:
- The spending these companies do on research and development as a whole is often a mere fraction of revenues; in many cases, the amounts spent on marketing are the equal of research and development costs, to say nothing of the tens of billions spent on things such as stock buy-backs which only serve to benefit their shareholders;
- Medical research in the United States relies heavily on public investment, with government and academic research providing a full third of all medical research funding. Other forms of public infrastructure, such as patent controls and the legal protection of courts, are not counted in those numbers, but ensure that these companies will continue to control and profit from the products they control, regardless of how this will impact the American public which utilizes healthcare in this commodified manner.
The same incentives are at play for many hospitals, where wards are routinely understaffed both due to the shortage of trained nurses around the country and as a cost-cutting measure to ensure hospital executives’ compensation packages are untouched. Again and again and again, we can see how healthcare provided by for-profit entities is, like every other corporation, focused on delivering profits and dividends over the services these companies are ostensibly created to perform.
The fundamental issue here is that healthcare, like many basic necessities of life, has become a commodity to be traded and invested in by the bourgeoisie, not something to be delivered based on actual need (what Marxists refer to as a social good). In this capitalist, commodity-driven healthcare system, decisions related to overall public health are driven by the logic of maximizing returns on investment as well, even if that investment is public funds intended to improve the health of the community. In this way, public health efforts in rural communities are painfully underfunded-the populations of these jurisdictions are small, and their wider dispersion makes it more expensive for healthcare to be made available in these communities. The growing threat of avian flu and measles outbreaks in rural communities highlights how neglecting the health of people in these communities has far larger bills than any public health program. In a system dominated even in thought by capitalist hegemony, however, healthcare decisions must always be seen as profitable endeavors first and foremost, and damn the consequences of that bourgeois outlook.
What would it look like if there wasn’t an endless drive of for profit directly gained from the people’s medical misfortune? The Cuban healthcare system, despite decades of embargoes cutting them off from most of the world economy, demonstrates remarkable outcomes in a number of population health metrics, surpassing the US in life expectancy and lower infant mortality rates despite having a much smaller economy. The key to Cuba’s success has been the community participation in public health and the availability of critical healthcare services throughout the country, even in rural communities. The Cuban system is one that recognizes the fundamental value of healthcare-not as a marketable commodity to be profited from, but as a social good worth far more than its monetary value. Healthcare is something we pour some of our highest technologies into, using teams of professionals with decades of learning and experience all to help one individual at a time. We have cared for the health of our fellow human beings from our earliest days as a species, because there are two understandings baked into our bones: That the lives of the people around us have value far beyond what any dollar can count, and that there is a time for everyone when they too will need other humans to help them.