As a Western society, we here in the U.S. are prone to viewing health in a compartmental manner. Even most religious folks buy into the Western model of medicine, save for a few who turn to prayer when disease strikes rather than accept medical interventions. Allopathic medicine is deemed to be rational and science based. Other systems of medicine, because the why of how they produce results cannot be scientifically explained, are viewed dubiously, and assigned a niche status. Allopathic medicine treats symptoms, it does not necessarily treat the underlying cause. For example, when a patient receives cancer treatment, the cancerous cells are removed, but the circumstances that led to their overgrowth — a stressful marriage, lack of nourishing food, poverty, exposure to chemicals in a dangerous job — may not be addressed. The person is pronounced in remission when the cells are gone. Depending on whether or not the confounding factors are removed, the individual may remain cancer free, or it may recur.
Healthcare policy in the U.S. is reminiscent of how allopathic medicine approaches cancer. We tend to focus on the symptoms of our broken healthcare system — coverage gaps, high premiums, etc. — and not on the sociopolitical forces, such as hypercapitalism and economic inequality, that have shaped the system into the hot mess it is. I was reminded of this similarity while reading an article on Humana, an insurer, pulling out of the ACA healthcare exchanges for 2018. Their reason for withdrawing: Too many sick people in the marketplace and not enough healthy people. And I thought, of course there are more sick people than healthy people in the marketplace. Your friends in the food, agriculture, chemical, financial services and assorted industries are making money hand over fist sowing the seeds of their illness! Like, you can’t be “pro-business” and support deregulation and privatization, and then be mad when that leads to people getting sick because they’re eating poorly, stressed out, broke, and toxic. The parameters for good health are myriad. Your social status affects your health greatly, and the amount of free time and expendable income you have determines what food you can access, whether or not you can make your own, whether or not you can participate in activities, and, of course, whether or not you can afford and access medical treatment. Besides the latter, these are issues that aren’t always considered in the popular healthcare debate, and the solutions our government has come up with don’t seem to address them effectively. It’s pointless to overhaul the healthcare system in order to save money when we’re not addressing the social ills that lead to individuals’ ills.
The fact that the healthcare exchange plans are serving individuals who may not have been able to access health insurance prior to the ACA plays a role in how many sick people are in them, as well. If people have been without healthcare, they’re going to be sicker than people who have been seeing a doctor regularly. The solution is not to deny them options by pulling out of the markets, and kicking them off their insurance plans. Give them an opportunity to improve their health. It might not be cost effective in the beginning, but I think it’s optimistic to think that a 100% coverage goal is ever going to be profitable in the short run. Possibly in the long run, but really, for-profit healthcare and the medical industrial complex are kind of monuments to why we’re so sick as a society. In general, we need to focus more on long-term social and quality-of-life gains rather than short-term economic gains.
The capitalist argument is that businesses should be profitable, not charitable, and since it’s not profitable to insure sick people, health insurance companies shouldn’t be forced to participate in markets that are lopsided towards the sick. This follows the popular argument that businesses should be free to do basically whatever they want, with minimal regulation or oversight, because they are “job creators” and and therefore precious to the U.S. economy. The fear seems to be that in a global economy, the businesses will just move to a country that’s less protective of their populace if we demand they be responsible citizens. But businesses adapt to different regulations and restrictions all the time. Tech companies modify their products to meet Chinese standards for government access. Companies like Johnson & Johnson have had to reformulate products for sale in the EU because certain hazardous ingredients were banned. And hell, look at what they’ve done to keep selling cars here in California. They’ve created cars with much lower emissions levels than they ever would have on their own, because it’s not in their interest to innovate on emissions. Too many people forget that corporations have a primary responsibility to make money for their shareholders. They don’t possess a conscience, and unfortunately a lot of CEOs appear to share that trait. Without any government oversight, corporations will run roughshod over a populace if that is where the profit lies. To believe anything else is naive.
It’s precisely because of corporations’ lack of conscience and lack of accountability to anyone but their stockholders that it’s irresponsible to entrust them with something as important as healthcare. The government is supposed to represent the people, is accountable by election, and therefore should, in theory, be invested in acting in the best interests of the people. To me, I would much rather trust my health to an entity that I have some leverage over regardless of how much money I have, rather than an entity that could really care less about me unless I own an impressive share of its stock. But some people are so distrustful of government that anything seems like a better option, which I will probably never understand. RIP single payer, 2009.
I wish I could say I’m optimistic about the eventual replacement for the ACA, but that would be far from the truth. As long as the GOP is obsessed with privatization, and centering corporations’ interests over the public’s while pretending they’re the party of morality, any solution they come up with will be woefully, almost maliciously inadequate. Only an approach that takes into consideration the holistic nature of health, both physical and social, will ultimately be effective in the long-term, and the current administration doesn’t show any signs of acknowledging that fact. Republicans in general seem less interested in making sure the 20-odd million citizens currently enrolled in ACA plans can continue to access affordable healthcare and more interested in kicking as many people as possible off the expansion of Medicaid to show they’re serious about entitlement reform. And of course, poor people are easy targets with little political, social and economic capital with which to fight back.
The next four to eight years are going to be rough for the oppressed and disadvantaged in our society as we are scapegoated to soothe the anxieties of a dominant group who fears their loss of majority status (among other things, it is of course not that simple). As someone who currently benefits from the expansion of Medicaid, I’m hopeful that the surge of popularity the ACA is currently experiencing will give Republicans pause before they completely gut it. But I’m keeping my expectations low.