The late BYU professor Hugh Nibley, speaking to a group of graduating college students, made the following observation: “Most of you are here (at commencement) today only because you believe this charade will help you get ahead in the world. But in the last few years things have got out of hand; ‘the economy,’ once the most important thing in our materialistic lives, has become the only thing. We have been swept up in a total dedication to ‘the economy,’ which like . . . (a) massive mudslide . . . is rapidly engulfing and suffocating everything.”
Historian and social critic Christopher Lasch elaborated on the same theme in his book “The Revolt of the Elites and the Betrayal of Democracy”: “The market notoriously tends to universalize itself. It does not easily coexist with institutions that operate according to principles antithetical to itself: schools and universities, newspapers and magazines, charities, families. Sooner or later the market tends to absorb them all. It puts an almost irresistible pressure on every activity to justify itself in the only terms it recognizes: to become a business proposition, to pay its own way, to show black ink on the bottom line. It turns news into entertainment, scholarship into professional careerism, social work into the scientific management of poverty. Inexorably it remodels every institution in its own image.”
This is exactly what has happened to health care in America. The profit motive has turned what was once a patient-oriented service industry into a greed-driven business proposition. And this explains why Republicans cannot come up with a workable health care plan. A common sentiment among conservatives, including Utah 3rd District candidate John Curtis, is that getting government out of health care and turning market forces loose would solve our problems. But this solution is like pouring gasoline on a fire. The problem is the market.
The reason is that health care is not a product. It is not even thousands of interrelated products. Health care, like education, is a public good. And when you try to turn it into a commodity, you unleash forces that turn it into a societal evil. “Do no harm” is the motto of the medical profession, but the profit motive, at every level of the health care field, does a great deal of harm.
Physician-turned-journalist Elizabeth Rosenthal has written a book that should be required reading for every American and, most particularly, every American politician. “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back” examines the health care industry in America and shows how doctors, hospitals, insurers, pharmaceutical companies, device manufacturers, the AMA, specialist lobbyists and many others have worked to make Lasch’s observation come true for health care.
Rosenthal offers 10 “economic rules of the dysfunctional medical market”:
1. More treatment is always better. Default to the most expensive option.
2. A lifetime of treatment is preferable to a cure.
3. Amenities and marketing matter more than good care.
4. As technologies age, prices can rise and not fall.
5. There is no free choice. Patients are stuck. And they’re stuck buying American.
6. More competitors vying for business doesn’t mean better prices; it can drive prices up, not down.
7. Economies of scale don’t translate to lower prices. With their market power, big providers can simply demand more.
8. There is no such thing as a fixed price for a procedure or test. And the uninsured pay the highest prices of all.
9. There are no standards for billing. There’s money to be made for anything and everything.
10. Prices will rise to whatever the market will bear.
Rosenthal illustrates these rules with scores of stories about people like you and me, with health issues that are very familiar. These stories show why health care does not follow the typical economic principles we associate with most products in our economy. This is because, once again, health care is not a product. If you treat it like one, it generally behaves exactly opposite what you would expect.
We need to start treating health care as what it is: a public good, like education, not a product. We need to get profit out of the picture. The profit motive does not produce good health care outcomes. It does harm. Most other countries have figured this out. Why can’t we?
Roger Terry is a writer and editor who resides in Orem, Utah.