Since my first year of college, I have never questioned my commitment to becoming a doctor. I want to make the most of my privilege to give back to those most in need. As social inequity and health disparity form a vicious cycle, medicine can be a powerful tool for social justice. However, I recently went through a bit of a crisis as I began confronting just how impractically expensive our healthcare system is.
How much am I really serving others if they cannot afford my treatments — if they must choose between relinquishing care or going bankrupt? American healthcare is costly, and I had to consider the implications of working within the entrenched, complex system. I wondered whether I would truly be fulfilled professionally if I kept my focus solely on individual patient interactions. As much as I treasure such personal service, I wanted to explore how I could make a broader impact on society.
As I began familiarizing myself with our healthcare system, I quickly realized how deeply it rests upon a single, powerful assumption: that our health is a commodity. We treat it as though it were any other good we can buy, such as a phone or a car. This means that it is subject to our capitalist economic framework, ultimately in ways that undermine both the purpose of our healthcare system and America’s very identity as a meritocracy through the ethos of the American Dream. As healthcare becomes an increasingly prominent political issue, one that will eventually affect each and every one of us, it is worth all of our time to examine the current healthcare system became commoditized.
One of capitalism’s foundational ideals is that people should be able to utilize their wealth freely, according to their desires and values. For example, I ought to have the freedom to spend all my money on gadgets while eating instant ramen every night. However, the fact that this is true of healthcare means that those with more wealth can afford better facilities and more expensive services, leaving the poor with underpaid caregivers and underfinanced hospitals. Moreover, while many people buy health insurance so that they can pay for future services now through monthly premiums, they can also choose not to.
This latter point is particularly significant because of the importance of “risk pools.” When an insurance company enrolls members in its plans, it sets premium rates based on how many services it expects its members, who altogether compose a “risk pool,” to use that year. If all of its members are healthy, the insurer has a “balanced” risk pool and can set low premiums while still making profit. The problem is that young and healthy individuals won’t bother buying good health insurance. So long as healthcare is a commodity, they are free to not prioritize their health insurance. However, insurers must raise premiums to compensate for unbalanced risk pools with disproportionately more sick members who need robust benefits. Thus, those who are sick and remain covered to receive health services are left to foot the growing bill.
More fundamentally, health is often paramount in our lives. It can be thought of as an “inelastic” good: demand for it is largely unaffected by price. The price tag means little for life-saving treatments, as we will find some way to empty our pockets and pay for it. We must; otherwise, we will die, and our money will mean little to us afterward. Hospitals can thus raise prices for such treatments and know that patients will continue seeking their services. As they do so, insurers must raise premiums accordingly, often to levels that the poor can hardly afford.
Here is the deadly irony. How can we believe in the American Dream, that those who work hard will reap the benefits of their efforts? Those who are poor and sick cannot access the care they need, nor can they “work hard” to “reap their benefits,” whether it be due to physical limitations or social stigmatization of illness. The reality is that if we view our health as something to be bought, our healthcare system will not be able to treat those most in need, nor will meritocracy be anything more than an illusion. Because of its centrality to our lives, our health and the care we receive must be the exception from the rest of our capitalistic goods.
I have been encouraged by the attempts over the years to treat our health as a right, to be protected by and for everyone. Medicare for the elderlyand Medicaid for the poor are perhaps the most notable, which operate through government subsidies funded by taxes. The Affordable Care Act (ACA, or Obamacare) has also made significant, though imperfect, progress toward this goal of making health a right. One major change is the individual mandate: a tax penalty is inflicted on anyone who opts out of health insurance. Most recently, Senator Bernie Sanders proposed the Medicare for All bill (already dubbed Berniecare), a single-payer model in which the government is the sole provider of health insurance. One of the biggest sinks of healthcare costs is administrative services. There exist countless insurance companies, each with their own policies and required paperwork. By creating a national, uniform system with a single-payer model, we can greatly improve efficiency and reduce costs.
Each of these steps has done some good for healthcare, but I agree that each has its own problems. People hate paying taxes, even for Medicare or Medicaid. Obamacare has not only violated our freedom to choose how we spend our wealth, but also forced people to purchase something they may not be able to afford. Now, Berniecare wants to put a lot of power and authority into the hands of the government, which has historically led to corruption and a whole host of other problems.
Though imperfect, I believe these proposed solutions are steps in the right direction. We must view our health as a right and not a commodity, especially if we want the American Dream to actually thrive. Unfortunately, the American healthcare system cannot be suddenly and radically transformed; rather, it is a mountain that must be moved a pebble at a time. Furthermore, it is an incredibly complex problem, of which I have only begun to scratch the surface. There is still far, far more that I do not know, but I am eager to learn. My hope for now is to start the more foundational conversation of what our philosophical view of healthcare should be. I have countless questions and hardly any answers — how do we make high quality healthcare affordable for everyone? How do we balance corporate and government control? Is cost-sharing beneficial? — but I invite you to search with me.