When It Comes To Healthcare, U.S. Has No Moral Imperative

It’s Just a Business, Not a Dignified System For Healing
By David Introcaso

In mid-July 3 Quarks Daily posted an essay written by Umair Haque, a London-based consultant and frequent contributor to the online Harvard Business Review, that argued “the American experiment is at an end.”   This is because unlike every other rich country the U.S. lacks essential moral universals defined as “sophisticated, broad and expansive public goods that improve by the year.” These include higher education, a responsible media, transport, welfare and healthcare. Democracies depend on these moral universals available to everyone because these benefits educate, inform and allow us to lead healthy lives. Absent these civilizing mechanisms we are left unable to act morally, democracy breaks down and we are left with our best universities churning out hedge fund managers, are economy recording paper profits and our media, when it bothers, debating climate change. We are left with perverse inequality, a declining middle class and falling life expectancy. Instead of our society producing a sense of “people cooperating by voting to give each other greater prosperity,” we have, Haque wrote, one that takes “prosperity away from one another.”
            Though she does not frame her work in these terms, that healthcare is far from a moral universal in this country is documented at length in Dr. Elisabeth Rosenthal’s recent An American Sickness, How Healthcare Became Big Business and How You Can Take It Back. Dr. Rosenthal, Kaiser Health News’ Editor-in-Chief, makes clear what poses as U.S. healthcare is neither a moral universal nor actually health care. Instead, what purports to be health care is a profit-maximizing industry with possibly at best only an incidental interest in actually improving our health. The “American health system,” Rosenthal states in her very first sentence, “attends more or less single-mindedly to its own profits.” Commercial forces “stole our healthcare.” It is therefore “rigged against you.”
            Arguing we have monetized healthcare delivery beyond recognition or that we have moreover medical commerce posing as health care, is not a difficult argument to make. Beyond ongoing efforts to sabotage coverage expansion under the Affordable Care Act (ACA) and the still unaddressed opioid epidemic, there are still more than one-in-ten Americans without healthcare coverage, our country is without a long-term care policy, integrating social service supports and dental care for the elderly are either completely, or largely, ignored, we care for a large number of the mentally ill by torturing them, we have made at best nominal progress in reducing medical errors and/or in measuring quality improvement, we appear to have no interest in correlating quality and spending; and, because health care is so inefficiently delivered we are forced to pay unnecessarily an additional $1 trillion annually causing us to both drown in medical debt and ironically forgo necessary care.
            Over the first two-thirds of her work, Dr. Rosenthal explains how the healthcare “industry” is designed such that “at every point there’s a way to make money,” or where “everything is monetized to the maximum, without much regard for the implications for patient health.” She does this using a 10-rule framework. Rosenthal’s rules include: More and more expensive treatment is always better; there is no free choice; there are no economies of scale and no competition; there are no fixed prices nor price transparency; no billing standards; and, prices are whatever the market will bear. 
             Rosenthal, moreover, proposes patients or consumers essentially challenge providers and payers by, for example, asking your physician why he/she is ordering a particular test, asking what is the pricetag for care before hand, vetting your hospital, shopping around for medications and requesting bill-itemization and/or negotiation. She makes these suggestions and related others because, she argues, “we patients have allowed this heist of our healthcare by commercial factors.”

            For example, concerning the absence of free choice, both my mother and wife had surgical procedures over the past eight months. When I attempted to learn more about both procedures, both surgeons as if reading from a script immediately responded by stating if I was not “comfortable” with them or their protocols they would be happy to refer me to another surgeon. (The first surgeon initially refused to physically examine my 85-year-old mother before surgery and the second refused to ensure my wife with prescription pain medication after surgery.)
            The relevance of Rosenthal’s work, particularly in light of Haque’s criticism, forces one to question how perverse or morally bereft the just concluded seven-month debate over repealing the ACA has been and more productively forces us to wonder how going forward health policy reform should be debated. Healthcare is not, cannot, simply be a cost or a tax paid at the expense of profit taking but instead be a public good, something that protects us, uplifts us, civilizes us, allows us dignity.

David Introcaso is a healthcare policy analyst based in Washington, D.C. A version of this article originally appeared at The Health Care Blog.