I’m offering chapters of The Ecology of Care: Medicine, Agriculture, Money, and the Quiet Power of Human and Microbial Communities for free here on Substack as the topics seem intensely relevant, once again. (I wrote the book from 2006-2015.)
Previous installments of the book start here.
Chapter 3: Medicine, Money, and the Global Pie
I didn’t become a health-care provider right away: my body led me there. I graduated from college during the economic boom of the 1980s and got a job working at a major magazine in New York City, deep in the world of capitalism. I shared a ten-by twelve-foot office in midtown Manhattan with four heavy smokers and a nonsmoking, bespectacled former newspaper writer named Allan, who took me under his wing. Allan had an embarrassing last name, which he said with dignity each time he answered the phone.
Our job was to write, edit, proofread, and fact-check special advertising sections. The department was euphemistically called “Creative Services.” Our subjects were Real Estate, which was booming; Vacation Dreams, which we had to imagine; and Sports and Fitness, which was just plain comical. Some of us were thin and some of us were wide, but none of us had ever seen the inside of the gyms we wrote about, and we complained about having to walk a few blocks from the subway to the finish line of the marathon in order to interview runners.
When fact-checking, we spoke with Donald Trump, Leona Helmsley, Mayor Ed Koch, ambassadors from India and France, and other skyscraper dwellers, while we made $16,000 a year. We wrote about swimming with sea turtles and driving race cars, while we sat in a dingy room with windows that didn’t open, literally cutting and pasting sticky text and photos with X-Acto knives, and staring into computer screens with glowing green letters that emitted small but continuous amounts of radiation.
By age twenty-six, my body was a wreck. I developed a cough that wouldn’t go away, I had headaches every day, my periods were horrendously painful, my pap smears were abnormal, and my back ached constantly, sending sharp pains down my legs. I went to doctor after doctor, but they didn’t have much to offer me, other than pain killers. I was still functional, but by no means was I actually healthy.
Health Care as a Means of Keeping Workers Functional
Although it appears that we are in charge of our own health, many of the choices we make about how to take care of ourselves are based on an underlying motivation: to get back to work as quickly as possible. Everyone is busy trying to keep up with rent or mortgage payments, utility bills, health insurance, student loans, car payments, and credit card payments. So, since people can’t afford to actually take time off from work to rest and recover, our health-care system is geared primarily toward keeping people functional, which isn’t always the same thing as healing or preventing illness.
Here are a few North American cultural assumptions that may be worth examining:
Being able to work is the measure of our health and worth.
It’s normal to work at least forty to sixty hours a week, with one to two weeks of vacation per year. Anyone doing less is not contributing their fair share to society.
Taking care of yourself is not something you should be paid for.
People who earn more money are entitled to better insurance, better standard and alternative medical care, better nursing homes, and more options for care.
People who are at a stage of life where they don’t work, such as children and elders, are not as “useful” or interesting to talk to as people who have jobs.
Old people who don’t have a lot of money, people with disabilities, people who are trying to process a lot of feelings, and people who have a chronic illness are an emotional and economic drain on families.
Illness, including “mental illness,” is considered a social and economic liability in our culture, yet this is ironic, because much of what we consider “illness” is really the body’s very clever attempt to heal itself. Fevers burn off viruses. Pain stops us from damaging our joints and muscles with overuse. Crying relieves stress. Fatigue encourages us to rest. Symptoms give us clues that there is an underlying problem that needs to be addressed, and that it is time to pay attention to our bodies and our emotions. Yet we do our best to cover up symptoms and make them go away.
What does our current economic and medical system do to keep people functional? It anesthetizes pain, lowers fevers, removes gall bladders, uses hormones to stop annoying hot flashes, and prescribes drugs to make people wake up, sit still, cheer up, and calm down. These treatments address the symptoms and allow the person to get back to being “functional” but rarely address the underlying cause. This is reactive medicine, rather than responsive or preventive medicine.
Not everyone agrees that health and functionality are the same thing. The World Health Organization, for example, defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
During my five-year stint in the smoke-filled office without windows, I was unwilling to simply take drugs to subdue my symptoms. Luckily, I was dating a carpenter named Tony who had a graduate degree in medical anthropology. Hearing me complain nonstop for the first month we were dating, he suggested that I go to the Integral Yoga Institute and try a class.
In those days, yoga was very fringy and mysterious. I loved the dark, quiet rooms. I loved the sacred chanting at the beginnings and endings of classes. I loved the white outfits the teachers wore, and being asked to notice the feeling of my body relaxing into the floor. I loved the way the person at the front desk spoke warmly and respectfully to me while handing me a towel, and I loved the way my symptoms started melting away as I got stronger, more limber, and more hopeful about life.
On Wednesday evenings after work, I began studying ancient Indian texts in the yoga teachers’ training program with Swami Asokananda—an American monk with a long beard who wore saffron high-tops to match his robes (and who also showed me how to jump over stadium partitions to get better seats at baseball games). I learned, among other things, that the word yoga is from the same root as the word yoke—to bring together, to connect. It is similar to ligio, the root of the words ligament and religion. Religion (re-ligio), I realized, was meant to reconnect, or relink, things that have broken off from the whole. This felt like what I was experiencing in my own body. Suddenly my undergraduate degree in “Oriental Studies” started to seem as if it might actually be useful. Soon I was teaching yoga on the side, after work, and thinking about how this concept of reconnecting related to my own life and health.
As my health steadily improved, I decided to explore alternative medicine as a career. I spent the next winter studying with an experienced acupuncturist named Robbee Fian, who was practicing illegally, half-hoping to get caught, as she had a lawsuit prepared to argue for the legalization of acupuncture in New York State. (Acupuncture was legalized in New York State a year later in 1992 and Fian went on to become the president of the American Association of Acupuncture and Oriental Medicine.) Five of us crowded into her small apartment and learned shiatsu, a traditional Japanese form of bodywork using pressure and heat on the same pathways used by acupuncturists. I loved working directly with my hands on people’s bodies—and I noticed that my own life long problem with cold hands had disappeared.
In 1991 Rupert Murdoch sold our magazine to a new conglomerate corporation, and I was given a choice: I could take on two people’s jobs for the same meager salary, or I could be laid off (thus saving a coworker her job) and collect unemployment. It was perfect timing.
I sent off two applications: one to a four-year program in acupuncture and herbal medicine in Seattle, the other to a massage school so I could get licensed in bodywork and help to pay my way through school.
As I collected my things from the office, a young coworker in the art department named Heidi poked her head in the door and said, “When you finish acupuncture school, you should move to Vermont. Trust me. You will fit right in.”
Profiting from Illness
Artist Steve Lambert is traveling around the US with a sign saying “Capitalism Works for Me,” and asking citizens to vote “True” or “False.”1 What interests Steve is not just the vote coming out of this, but also the conversations he is having with people as they think about how to vote. One conversation with a physician caught Steve’s attention: “Capitalism is working for me,” said the doctor, “but it’s not working for my patients.” The doctor went on to say that most of the illness he sees is caused by capitalism.
What does he mean? What is the relationship between capitalism, health, and health care? And maybe more importantly: what is the relationship between the growth economy (the need to make greater and greater profits because of the foundation of debt that our economy is based on) and our desire to look out for each other’s well-being?
The doctor that Steve interviewed, a specialist in endoscopic surgeries, explains that innovation in the medical profession is driven by investment, which allows people to invent new products and new technology. On the one hand, he sees that innovation is a good thing, because we have more tools with which to diagnose and treat illness, but on the other hand, when you put it all together, there is something very dark about the whole setup. Innovation is only needed, he says, because we let people get unhealthy, and that is the unsettling reason for why we are at the forefront of technological advancements. He says capitalism works for him as a doctor for one reason only: because if the system was supporting every one to do what they are supposed to be doing—taking good care of themselves, eating well, spending time with their families, and having a meditative practice—he’d be out of a job.
The White House Asks for Our Opinions
Just after Barack Obama was elected in 2008, the Obama–Biden transition team called for small meetings around the country to discuss problems with the current health-care system, and I was invited to one of those meetings. I had been practicing alternative medicine for fifteen years, and this was the first time I had ever been invited into a meeting with mainstream providers.
First, we were asked to make a list of all the problems we could think of with the current health-care system. One of my neighbors, an oncology nurse, took notes on a large piece of paper, while the health-care providers around me called out their ideas:
• “Doctors don’t have enough time to spend with patients.”
• “Uninsured people go to the emergency room for basic care.”
• “High prices for insurance, and high medical costs for the uninsured.”
• “Doctors are stressed out, and overworked, which leads to more medical errors.”
• “No one in the medical profession feels fulfilled with their work, because they can’t practice in the meaningful way they want to.”
• “There is no funding for preventive care.”
• “Insurance companies refuse to pay for certain things; they have preexisting condition clauses.”
• “Bills get sent back and forth with nitpicking details. Different rules for each company.”
• “Providers’ offices are overwhelmed with insurance paperwork, creating higher costs.”
• “Doctors can’t afford to work on their own because of high malpractice insurance rates.”
• “There is no funding for research on drugs that aren’t expected to sell well.”
• “We pay more for medicines and procedures here than in other countries.”
The proposed meeting agenda from the White House then asked us to rank a list of possible solutions they had come up with for the health-care crisis (which included a three-tiered “public” option that perpetuated the inequities of our three-tiered economic and class system). But none of the options the White House was offering seemed to address the root of the problems we had listed.
The people in my group were not exactly my peers—alternative providers got little respect from standard providers in those days—but I took a deep breath, and asked those gathered to turn the topic of the meeting toward the idea of a total rethinking of our medical system. The room became quiet.
I posed a hypothesis: is it possible that profit is the root of all the big troubles of our current system? If everyone working in health care, including those developing drugs and technology, were paid a decent wage, but no one was making a profit, would the big problems go away?
People nodded. They seemed interested in what I was saying, so I continued. I suggested that most of the problems we see in both standard and alternative health care today, and even in people’s health today, are related in some way to the way profit motives influence health care, and that our health would improve dramatically if we removed profit from every aspect of health care.
To my surprise, the doctors, nurses, psychologists, and medical researchers at the meeting were open to my idea, and they started giving examples from their own life and work of times when money had completely trumped ethics in medicine. Many of their examples were shocking to me, and two in particular stood out because they demonstrated the way profits influenced even nonprofit organizations.
In the first example, a doctor saw architectural plans for a new renovation at a so-called nonprofit university-based hospital, alongside a map of the current hospital. As he looked at the plans, he realized with horror that the little numbers drawn on each area were not square feet, but rather dollar amounts. Each area was mapped out based on the income it currently provided, or, in the case of the renovation, the income it was expected to provide. The new space was designed to maximize revenues, with less space for such areas as drug detoxification, which tend to bring in less money, and more space for high-profit activities, such as heart surgery. People’s actual health needs didn’t seem to be reflected in the design at all. For example, the new hospital’s design disregarded the fact that the area’s local population desperately needed more inpatient rooms for people trying to recover from addictions.
Another example offered at the meeting was from someone who had worked on research projects that were funded by pharmaceutical companies but housed in “nonprofit” universities. The researchers were routinely asked to sign “gag rules,” which stated that if they leaked any information about the research results without permission from the pharmaceutical company, they could lose their jobs. This meant that even if research was showing something dangerous about a drug that was about to hit the market, no one could talk about it without permission from the company funding the research.
Nonprofit hospitals and university research labs are supposed to deliver services for the public good, which the government would be delivering if nonprofits didn’t exist. They are allowed to be nonprofits because they are acting as a proxy for the government itself. Yet according to Paul Starr, Pulitzer Prize–winning author of The Social Transformation of American Medicine, nonprofit hospitals are often a “beehive of corporate activity,” and include many profit-making activities that don’t affect their tax-exempt status.2
In medicine, the two worlds of for-profit and nonprofit are often inextricably intertwined, both ethically and financially. And how could they not be? Although many hospitals, universities, and insurance companies qualify for tax breaks as nonprofits, they still operate entirely within a profit-based medical economy. It seemed clear to me, from my own experiences and the stories I was hearing, that something needed to shift, not just in my own life, but also in the larger health-care system.
Creating Illness: The Power of Advertising
My friend Marie worked for many years as the “Director of Care Management” at a small hospital, but this didn’t stop her from falling into a health-care advertising trap. During a routine physical, a doctor asked Marie if she had any issues with urination. Marie mentioned that ever since she had given birth to her first child, she had to get up a couple of times a night to pee, and had to stop work to urinate several times a day. The doctor, who was sitting in for Marie’s regular doctor, told her that she had symptoms of something called “overactive bladder syndrome” and that there was a new drug she could take called Detrol. Marie filled the prescription and started taking it. The need to get up at night lessened, but she developed strange side effects. She went online to do some research and realized that both she and her doctor had been duped.
In the late stages of a growth economy, the things that are being sold get further and further away from the basic necessities of life. The useful, easy-to-sell items are already being marketed, so people start trying to trick each other into buying things that aren’t actually useful. You can see this at work in all aspects of our society— including health care—with more and more products and services (that have less and less to do with our actual needs) being pushed at us with increasingly aggressive advertising.
Author Melody Peterson, in her book Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs, describes how Pharmacia corporation created a fictional illness called “overactive bladder syndrome” in order to get people to buy the drug that Marie was given.
Peterson attended a global summit of pharmaceutical marketers where the vice president of Pharmacia gave a presentation entitled “Positioning Detrol, Creating a Disease.” During his presentation, the executive explained how the marketing campaign unfolded. First, long before the public first heard of the drug, the company paid to have articles about “overactive bladder syndrome” (the invented illness) published in a prominent medical journal, Urology, so that doctors would already be thinking about it when patients came in to request the drug.
Then they let the public know about the “epidemic” of overactive bladder syndrome through the news media, which reported that it was a “serious affliction affecting as many as one in four adults.” These news reports (prompted by press releases from Pharmacia) came out weeks before Detrol hit the market.
Next, Pharmacia paid doctors to talk publicly about the “profound” effects that having to urinate nine or ten times a day could have on a patient’s life—from sexual dysfunction to emotional problems. Finally, Pharmacia hired the actress Debbie Reynolds to create a public awareness campaign about “overactive bladder syndrome” and the treatment that was available with the wonderful new drug called Detrol. Reynolds gave interviews about it to the Saturday Evening Post and other media.
Susan Brody picked up the story for the New York Times health column, and soon a new disease was born. But so was a new problem. Detrol has many side effects, including anticholinergic effects that create Alzheimer’s-like symptoms of dementia in some patients who are taking it, particularly if they are on multiple medications. Unfortunately, once you have convinced the public that they have a serious disease, it is harder to convince them not to take the medicine.
A few months later, my friend Marie was getting recurrent urinary tract infections, and she went back to her original physician. He was able to trace it back to the prescription for Detrol. He suggested that Detrol was causing her to retain urine unnaturally, creating an environment for infections, and that she should go off the drug. “But what will I do about needing to pee too frequently?” she asked.
He laughed, “Marie, you learned that in nursing school, you teach it to patients! All you have to do is retrain your bladder, by waiting a little longer each time, until it is back to a normal schedule. It will take a few weeks, and you’ll be fine.”
She did as the doctor suggested, and quickly relearned how to sleep through the night and urinate at more reasonable frequencies during her workdays.
Many new diagnoses, including “osteopenia” (low bone density), “premenstrual dysphoric disorder” (irritability before menstruation), “GERD” or “gastroesophageal reflux disease” (heartburn), and “social anxiety disorder” (shyness) are actually relatively benign, commonplace issues that have been relabeled as full-fledged disorders in order to sell drugs.
Vince Parry, a pharmaceutical branding expert, traces this strategy back as far as the 1920s, when the manufacturers of Listerine purposefully created anxiety around a new condition called “halitosis” (bad breath) in order to boost sales of an antibacterial product used topically for things like wound healing. In advertisements, the manufacturers played on people’s insecurities: blaming halitosis for everything from lack of career advancement to divorce. In response, sales of Listerine jumped from $100,000 to $4 million over the next six years. In a chilling article in Medical Marketing and Media, Parry calls this process “the art of branding a condition,” noting that marketers are now taking their ability to create new disorders “to new levels of sophistication”3
Today, the seeds must be sown in a complex landscape of audiences involving pharmaceutical companies, external thought leaders, support groups, and consumers; and the effort must be coordinated with multiple communications agencies in the fields of branding, advertising, education, and public relations.
If done appropriately, condition branding has numerous benefits, the greatest of which is how it creates consensus internally and externally. Such consensus serves to keep brand managers and the clinical community focused on a single story with a lock-and-key problem/solution structure.4
Pharmaceutical manufacturers, on average, spend $19 on advertising for every $1 spent on research.5 That’s because it is much easier and more profitable to develop new customers than to develop truly useful new drugs.
The Case Against Competition in Medicine
Even if you think competition is a useful creative force in other economic areas, it’s important to understand that in health care, competition and the quest for profits do not actually increase quality or keep prices down. The whole concept of a “competitive market” assumes that there are consumers shopping around for high quality and good deals. But in medicine, consumers do not actually have access to the information they would need in order to shop around.
During my financial crunch, I went to get a mammogram. I walked into the hospital for my appointment and was sent down the hall to the registration desk. While there, I explained to the older woman behind the desk that I wanted to know ahead of time how much it would cost. Since I had a $10,000 deductible for my health insurance, I knew I would end up paying for the mammogram out of pocket.
“The last time I got a simple blood test at the hospital down the street it cost me $700, and I still haven’t paid it off, so now I always ask first,” I told them.
As soon as I said that, the woman handed me a clipboard and a pen. “You need to sign this form before you can get your mammogram,” she said.
I looked it over. Basically the form said that I promised to pay for all bills, and all legal fees associated with nonpayment of bills.
“But I can’t sign this form until I know what the charge is going to be!”
She looked tired of me—and she had only just met me. She rolled her eyes and said, “This is going to be complicated.” She called across the room to a woman from billing.
“How much will the charge be for a mammogram?” she said to her coworker, with a tone clearly meant to prove to me that my question was pointless.
“I don’t know,” said the woman from billing, without looking up from her desk.
“See?” said the older woman, “we don’t really know.”
“How can we find out?” I asked, undaunted.
They both went down the hall to ask someone else, leaving me to read the “patient’s bill of rights” on the wall.
Time passed.
“We don’t have that information,” was the answer that came back.
“Well, someone here must know!” It seemed absurd to me that the people in billing couldn’t find out a price.
“Let me check something.” The woman from billing went and got a procedure code and read it to the woman who was checking me in, who then tried to decipher the list of charges.
“Look, it says here that it’s $250 for the mammogram, but there’s no way for us to know how much the radiologists who read it charge, because they bill separately.”
“Right. We don’t know that part,” agreed the coworker.
“Can we find that out?” I asked.
“I think it’s about $35,” said the woman from billing, cheerfully trying to settle this conversation.
I persisted. “That’s fine, but I’d like to know for sure.”
She and I walked down the hall to the radiology department. Luckily the hospital was not very busy. I seemed to be their only patient.
A young, confident-looking woman with jet-black hair at the desk in radiology started looking around in her computer and said, “Well, the mammogram itself is $125 . . . now let’s see what the radiology charges are.”
“No, the mammogram is $250, we just looked it up,” said the billing woman.
“Oh, I’m sure it’s less than that,” said the younger woman, with a confidence that was no longer reassuring, “but the reading by the radiologists . . . hmmm . . . I don’t know. I think it’s about . . . $175?”
In the end, no one—not in billing, nor in the specific departments themselves—could tell me the full price of the mammogram. They all agreed that they just didn’t know; they didn’t have access to that information.
I went back to the woman at registration and said I was sorry, I couldn’t sign the form. So she canceled my mammogram, and suggested, as I was leaving, that I cancel my insurance as well.
“Really, why?” I asked.
There was something in her tone and facial expression that had shifted. I could tell she had decided she liked me, and I found myself trusting whatever she was about to say.
“If you were uninsured, we would charge you very little for this mammogram, or any other procedure. But since you do have insurance, even though you have a $10,000 deductible, we will have to charge you at whatever the highest rate is—that’s something I know for sure. And around here, if you are uninsured, you’ll actually get better care.”
I went home and canceled my health insurance.
I was lucky. After a long and somewhat scary waiting period, in which I was literally relying on the kindness of strangers for my health care, I became eligible for inexpensive health insurance through the State of Vermont.
A Supermarket Without Prices
What would it be like to shop at a supermarket without price tags, and then be told at the checkout counter not to worry—someone will bill you later? What if the cashier asked you, as you loaded your items onto the counter, to sign a form saying that you were responsible for the bill, and for any legal fees that arose if, after you received the bill, you couldn’t afford to pay it? What if you were told that the prices actually varied from person to person—not based on their income, but based on negotiations the market made with other, third-party participants? Who would shop at a supermarket like that?
Yet this is exactly what we face as consumers in the world of medicine. Very few people know how much medical treatments cost, nor is it possible to find out in a time frame that would allow patients or providers to compare options. Prices for health care—even if they are known—aren’t stable or predictable. The market is segmented, and transactions are hidden. Therefore, you can’t shop around because there is no easy way to do a price check. This is the first reason that health care in the US is not a “free market” or “competitive market” in the usual sense of those words.
The second reason that health care is not a competitive market has to do with the fact that insurance companies operate as middle men between patients, caregivers, and the institutions of care, so people don’t have to think about prices. This leads to a situation in which both consumers and providers in the United States act like some entitled teenagers do when they have access to a parent’s credit card: not caring how much something costs, or whether it is the best value; simply racking up one charge after another. No one takes full responsibility for evaluating the costs or considering the effects of their spending on the steadily rising prices.
In a single-payer system like Canada’s, national insurance pays for all the heart medicine that is prescribed to Canadians, so they can negotiate a set price with the manufacturer that applies to every one in Canada. This gives the Canadian government market power to keep the cost of drugs relatively low and stable, which is why drugs cost less in Canada than in the US. Here, different insurance companies and hospitals are willing to pay widely varying amounts for the same medication or procedure because no one knows what anyone else is paying, and patients who are insured are made to feel as if they are paying nothing at all, which of course is not true.
Even with Medicare, federal law prohibits the US government from using its buying power to negotiate lower prices with pharmaceutical companies—which, if it were allowed, could save the government an estimated $1.4 billion a year.6
[Note: As of August 2024, the prices for 11 drugs are now being negotiated by the federal government, but this is only for people with Medicare. The change in prices will not go into effect until 2026, and this tactic has not been expanded to lower prices in the broader pharmaceutical industry78.]
The cost of even simple drugs varies wildly depending on the place and setting, with some hospitals routinely charging $1.25 for a single aspirin—that’s 100 times the price a patient would pay at a drug store. A nutritional supplement called L-Glutamine, which I sell at my clinic for $37, costs $300 at the Walmart pharmacy. For an opiate such as Percocet, it might be the other way around, costing far more on the street than when doled out by a pharmacist.
The Difficulty in Calculating Value
Knowing what things are worth in health care is also intrinsically more confusing than in other markets.
With automobiles, people know what they are getting and what they are spending. You know that a Ferrari goes faster than a Ford, and that it will also cost more to repair. If you buy a used car, you can look it up in a book or online and see what it is worth. If a new car doesn’t work the way you expect it to, you have a warranty. Not so in medicine.
How, exactly, does one assess the comparative value of a drug or procedure in which there are no guarantees of outcome? Is Prozac a better antidepressant than Wellbutrin? Is surgery to remove a tumor better than radiation to shrink it? The same procedure could save one person’s life but end another’s, while having no effect whatsoever on someone else. So how do you calculate its value? Doctors have a hard time helping patients navigate choices in health care because the system is too complicated and there is simply too much to know, so price does not operate as a signal of actual value and outcome. Therefore the free market fails in its information role in health care in a way that is quite different from other markets.
The most common argument for keeping health care in the private (profit-making) sector is that the quest for profits creates a competitive market—and by having a competitive market, the quality of health care goes up while costs go down. Advocates of this free-market approach argue that having a free market, where customers can shop around, improves the quality of health care because people pay more for things that are better. But it simply does not work this way. We have been participants in a great test of this theory, and it’s quite obvious by now that it isn’t true.
The United States spends far more on health care than other countries do—nearly double that of the rest of the “developed” world—and the quality and outcomes are dramatically worse.
The Institute of Medicine ranks US citizens’ health and life expectancy at the bottom of the seventeen most developed countries in the world, while we spend more of our GDP (17.9 percent) and more per capita than the other sixteen countries.9 [In 2021, per capita spending was nearly twice as much as the average of other comparable countries.] Compared to all other countries, the World Health Organization ranked the US health-care system thirty-seventh in the world—when looking at life expectancy, quality and speed of services, privacy, and fair distribution of services.10
Do Investors Understand Medicine?
So if competitive markets aren’t creating better-quality health care, then where does the “capitalist” or investor belong in health care? There’s no doubt that people who take care of other people, develop drugs, perform surgeries, and figure out puzzling scientific questions should be paid well. These are fine jobs, which often require years of education and experience to do well. These are jobs that change people’s lives and save people’s lives. Yet the “capitalist” is rarely the researcher, the surgeon, the nurse, or the biochemist. The capitalist hires these people, and makes money from what they do.
Nowadays the capitalist or investor is usually a group of people: CEOs and stockholders. Most of them don’t necessarily need to know anything about medicine—other than about the potential profits to be made. Do investors really have our health as a priority?
Let’s say we pay the doctors and researchers their salaries, the same as ever, so they will have just as much motivation to keep working on cures. If the costs were shared by the people who participate in the system, why would we need the stockholders siphoning off billions of dollars for their own pockets?
Perhaps even more importantly, why should there be people making decisions in our health-care system whose main objective is to make a profit? How does this influence the treatments we are offered, and the ones that are left off the list? On an even larger scale, how has capitalism itself—and the competitive mentality it is based on—changed our view of what the terms health and health care mean?
Justin Ritchie, “Episode #36 Art into Action” interview with Steve Lambert, The Extraenvironmentalist, podcast audio, February 16, 2012, http://www. extraenvironmentalist.com/2012/02/16/episode-36-art-action/ and personal correspondence with Steve Lambert.
Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Harper Collins, Basic Books, 1982).
Vince Parry, “The Art of Branding a Condition,” Medical Marketing & Media, May 2003, 43.
Ibid.
Donald W. Light and Joel R. Lexchin, “Pharmaceutical Research and Development: What Do We Get for All That Money?” BMJ:345, August 2012.
Ethan Rome, “Big Pharma Pockets $711 Billion in Profits by Robbing Seniors, Taxpayers,” Huffington Post, April 8, 2013.
https://www.hhs.gov/about/news/2024/08/15/historic-first-biden-harris-administration-successfully-negotiates-medicare-drug-prices-delivers-promise-lower-prescription-drug-costs-american-seniors.html
https://www.whitehouse.gov/briefing-room/statements-releases/2023/03/02/fact-sheet-president-bidens-cap-on-the-cost-of-insulin-could-benefit-millions-of-americans-in-all-50-states/
Steven H. Woolf and Laudan Aron, editors, US Health in International Perspective: Shorter Lives, Poorer Health (Washington, DC: National Academies Press, 2013).
The World Health Report 2000: Health Systems: Improving Performance,” World Health Organization, accessed May 27, 2015, www.who.int/whr/2000/en/. [See 2024 here: https://www.who.int/data/gho/publications/world-health-statistics]
