Thursday, May 9, 2019

The imbalance of Healthcare and Capitalism?

Everybody deserves healthcare, and medicines that cure diseases, eliminate allergies.  Today’s innovation in medicine and care help reduce pain, anxiety and depression, improve nutrition and provide hope and well-being for those with diseases such as cancer and AIDs live long and healthier lives.

In a world where most countries provide healthcare as part of their society where does that leave the US?   Since I left the safety of a larger employer such as IBM, every career move has had the underlying worry will I have health insurance.  It isn’t just a discussion of costs; it is a discussion as a middle-age male it gets harder to get coverage that is also affordable.   Obamacare helped stabilize the costs, and made it easy to sign up, but with the attacks from the political right the concern that leaving employment, to say be an independent contractor can come with its own set of challenges.

Why should a citizen of this country not have access to basic healthcare, and from an economic point of view how can healthcare providers make money where the sicker we are, the more we need insurance and financial support, and the more expensive our care is.  When we are healthy, we may or may not avoid doctors.  When we are young and feeling invincible, we many choose not to buy insurance, whose premiums would help reduce the burden for these companies to pay for the care of those who are truly sick. 

Obamacare tried to make health insurance a requirement, just as states mandate that most people who own cars insurance and is a requirement to register a car or get a license even.  Those mandates make car insurance a profitable business and probably help with affordability as well.  But car insurance is not focused on maintenance of the car.  We expect health insurance to not only cover us when we are truly sick but also "routine maintenance of our bodies" like physicals and the like. Imagine if car insurance also included the tune-up and oil changes what the cost and profit picture might look like.

On the flip side, and what started me writing this is my continued quandary around the role of capitalism in medicine is an article in this weeks Business week that exemplifies the challenge.  The article Antibiotics Aren’t Profitable Enough for Big Pharma to Make More highlights that pharmaceutical companies are disinvesting in antibiotics research because there is a little money in developing newer ones.  Especially as doctors have grown concerned about drug resistant bacteria and wanting to hold off using newer meds to assure, they are available when truly needed.

In the world of capitalism, if your disease happens to be a profitable one then researching a cure moves your disease and cure to the front of the line.  Antibiotics, that helps millions and we need newer ones to combat drug resistant strains of diseases are not so pharmaceutical companies are limiting research and smaller players are going out of business. 

If healthcare is for all and effectively not driven my markets and profits would we be better off?  Would governments and universities step in to fund the missing research as pharmaceutical companies look to more profitable business?  or will we effectively slow down medical innovation to the pace of government?

I really don't know the answer.  I don't think people should die or not have good care because they are poor, lazy, or homeless. I also don't believe just because one is rich their healthcare should move to the front of the line for care such as transplants and other expensive health services.   But, in a world that is driven by capital and profits how do we keep the innovation in healthcare that has helped millions of people around the world?

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