"We have the best health system in the world," said my neighbor, "so how could all this happen to us?" I recalled my discussions with my public health students. The US doesn't have a health system. It has a health industry. More accurately, it has a "medical–industrial complex" as first explained by Barbara and John Ehrenreich in the November 1969 issue of the Bulletin of the Health Policy Advisory Center in an article entitled "The Medical Industrial Complex".
Fast forward to 2020 and nothing has changed. It's still a medical industrial complex which by its very structure makes it rigid and unresponsive to the caregivers and people who need care. I thought about how to answer my neighbor. My BFF, Sista, who often teases me about using fancy professor words, says I should just talk flat. So here goes.
The US has a health industry not a health system. That means it's about making money. All kinds of for-profit companies make money in it. Some make machines like respirators or walkers. Some make hospital beds. Some make syringes. Some make the drugs that go into them. And, the insurance companies make money by promising coverage from monthly fees but then denying most of it with big upfront deductibles and copays. It's a bunch of medical supply stores selling their products for profit to hospitals, clinics, home health agencies, and you.
Like most stores selling special gadgets, they have their own supply chains which are often top secret. No need to give away company secrets. So, a medical supply company or store, that sells test kits for Covid 19 might set up its supply chain from other companies worldwide at a good price. For example, a US company gets their swabs made in Italy. Because the supply is shut down from Italy's struggle with the pandemic, that US company can't get what it needs. My neighbor then said, "Why don't they use a Q tip? I have plenty laying around?" Well, you see, it's just that a swab for a Covid 19 test is not a Q tip. This company needs its own special design from Italy. So, they're stuck. Can't make them. So, we can't test people with a uniform standard kit and can't track their contacts, which would happen in a health system, but not a health industry.
"That's crazy," she said. I agreed but pointed out that just as Amazon ebooks use kindle only, other ebooks use other tablets. All are ebooks but they don't interchange on the readers. They compete. Same with medical supplies. The health industry runs by the rules of competition and unique designs, but not cooperation. It's like cell phone chargers. Apple chargers won't work with Android, but they are all chargers. Doesn't help if you have the wrong one.
My neighbor shakes her head. "Wow. All this time I thought we had a system. I thought someone was in charge if something like this every happened." I said what national health leadership we had at the CDC was fired by the current president. Her blue Keep America Great flag fluttered by the porch door. I had to tread lightly.
I thought of the social theorist, Karl Polanyi. In, The Great Transformation: The Social and Political Origins of Our Time , he writes that social aspects of society having to do with housing, education, health care, can be hurt if run by pure market driven industries. Real estate flippers, underfunded public schools, and no public option in the ACA are real hardships for many average working people especially minorities, immigrants and people of color. All people need social services if they are to be the healthy labor force needed by the rest of the industries of the economy. A capitalist economy can't run on dead workers.
So, I turned to my neighbor and said it won't hurt business if there was a national health system to handle health care including pandemics. It would keep the people and the planet healthier. We'd still need the medical industries since the states and federal government would contract for their supplies based on peoples' health care needs. And the insurance companies would be needed to administer a national health system just like it's already been doing for Medicare. Actually, the easiest and quickest thing to do is make Medicare open to everyone, children and adults, since it's already set up.
"Well, I don't know," she said. “I figure we have that already. If you need a doctor, just go to the ER. And, the hospitals need to get their act together. They should have planned better and stocked up on ventilators for this virus. Hey, gotta go. President having his press conference now."
I waved goodbye. Guess I didn't talk flat enough. Big business is never going to care about you. The big businesses of the health industry won't ever deliver care. It's not their purpose. And so, I glance at the latest death count coming from New York, knowing it will exponentially grow, too, where I live. I grab my earphones and tune into the compelling The Red Nation Podcast (therednation.org) and imagine an alternate future focused on people rather than profit.