In health care, as in hunger and housing, we face a moral choice. Is Mammon or caritas — profit or well-being — the best driver of community health initiatives?
In “Paradise Lost,” the poet John Milton tells us that “… others have forsaken Mammon in search of something on a more spiritual plane.” Four hundred years later, it’s time to choose again between personal gain and the common good.
If a shared morality is indeed the basis of a just society, are we right to leave the health and well-being of our citizens to profiteers?
With consistent and strategic regulation, capitalism and the profit motive can be great drivers of social well-being but not, as many neoliberal conservatives insist, for every obligation of government — a primary one of which is the health and well-being of its citizens.
President Reagan’s classic line — “… government is not the solution to our problem; government is the problem” — promised a bonanza to those seeking to profit from privatizing government’s intrinsic obligations to ensure the well-being and security of its citizens. Efforts to privatize the postal system, public transport and highways, prisons, and the military have all come to pass to varying degrees. Our current health care system is fragmented between the for-profit, nonprofit, and government (VA hospitals) sectors.
In America today, 35 million people are hungry, 550,000 are homeless, 2.3 million are in prisons (70% of whom suffer from either mental illness or addiction), and 6 million kids are affected. Thirty-four million live in poverty. A third of our elders live alone, a known source of physical and mental health problems.
If we are to truly address these problems — to which can be added adverse childhood experiences (ACES), illiteracy, addiction, disability, racial discrimination and environmental degradation — we must start by understanding them all as preexisting health conditions, and their treatment integral to delivering effective health care.
An effective health care delivery system will integrate a number of institutions: Pharma, nursing homes, dentists, hospitals, addiction and mental health facilities, clinics, private practices, corrections, food systems, and schools — even though it’s more convenient to think of them as separate entities. In fact, it’s in each’s best commercial interests to be viewed as a separate business entity. But we’ll never achieve true community wellness until we see and treat these elements as parts of one system.
But first, we’re going to have to agree on our moral priorities. If the health care system continues as it is now — managed for profit even in the “nonprofit” realm — we’ll never achieve the goal of improving our national wellness as long as the business of repairing sick people is more lucrative than educating citizens and investing upstream in prevention.
Cost is the most touted objection to a national health care system. But the glaring irony here is that we are the most expensive health care system in the world, and countries with a free national health care system provide much better outcomes at much lower cost. A study last year by Yale lays out the data clearly.
The business model for emergency rooms, dentist offices, nursing homes, addiction treatment facilities, pharmaceutical companies, all depend on a steady influx of sick people. And Pharma by creating drug dependency and other “side effects,” the industrial food chain, polluters, prisons, and nursing homes all ensure a steady stream of sick customers. In the last year, the coronavirus has demonstrated how nursing homes and prisons became major generators of illness and death during a pandemic.
One would assume that the core mission of nursing homes would be wellness, yet the great majority — 70% — are now owned by private equity companies dedicated to wringing profit out of these “care homes.” It’s been well documented that, on being acquired by private owners, steps are taken to lower staffing and care levels to wring out greater profits. When profit is the prime motivator, cost of care will necessarily be compromised. Forty percent of all Covid-related deaths have occurred in nursing homes and a host of lawsuits are being brought against homes that provided substandard care. But under pressure from industry lobbyists, many states have passed laws indemnifying nursing homes from lawsuits.
Greystone Nursing Homes, whose executives gave $800,000 to President Trump, are epicenters of Covid-19 deaths. Furthermore, in nursing homes where seven in 10 residents were Black and Latinx, death rates were 50% higher than those with predominantly white populations. In any scenario in which health care becomes a national commitment, nursing homes must either be strictly regulated or remanded to the nonprofit sector.
The pricing and addiction disasters Pharma has perpetrated on Americans are well documented. I and others have written about them extensively. Could we ever imagine a nationalized pharmaceutical industry or, at the very least, a regulated one? Medicines should be developed and deployed for the benefit of Americans, not solely as profit generators for a tight-knit group of oligarchic families.
A clear vision of how such a system might be delivered cost-efficiently is brought to life in a Vermont film produced last winter by Bear Notch Productions titled “Restoring Balance: Healing in the Face of Adversity.”
Using The Health Center in Plainfield, the film does a masterful job of showing how a patient-centered, integrated understanding of health care can lead to affordable community wellness, while making several key points:
- While 20% of Americans live in rural areas, here in Vermont, 60% do.
- Rural areas have 30% fewer primary care physicians, yet higher rates of addiction, heart disease, diabetes, stroke, and cancer than urban areas.
- Vermont’s 11 federally qualified health centers see 180,000 patients a year, about a third of Vermont’s population.
Vermont has 14 nonprofit hospitals and two academic medical centers, including New Hampshire-based Dartmouth-Hitchcock. For the most part, they’re effective at fixing broken people, but, looking forward, all must be held more accountable for their efforts to prevent illness through education, early intervention with primary (pediatric and geriatric) care, and aggressive social advocacy to reduce the precursors of illness mentioned here.
Confirming health care as a basic human right in law is the natural starting point. Are we ready to join most of the rest of the world and acknowledge health care as a basic function of government, if not a human right?
