"Good business is where you find it."
This is a line from the 1987 movie, "Robocop", which, in addition to being about action, explosions, and robots, characterized a very cynical view of how our nation views the relationship between business and public services. In the film the fictional corporation, Omni Consumer Products, boasts about privatization and profit from every sector imaginable; from military to healthcare, to police and everything in between. The movie then demonstrates the magnitude of harm that results from treating public services as enterprises for profit. There is increased poverty and crime. There is an ever widening income gap. There are people who are dying because they can't afford services.
This is what I think about when someone like Alex Azar speaks of increasing competition in the healthcare system in order to improve it.
Alex Azar, former general counsel for Health and Human Services under George W Bush and a former president for the large pharmaceutical company, Eli Lilly and Company, is going through the confirmation process in the Senate to become the US Secretary for Health and Human Services. It is true that he has thorough knowledge of both government and private business approaches to the healthcare system, and has profited greatly in the pharmaceutical industry from the high costs that pharmaceutical companies charge for their products. Some could say that makes him a perfect symbol of what our nation's healthcare has become.
Azar recognizes that there is a major problem with the high costs of healthcare in our country, and favors the approach to lowering healthcare costs through more competition in the market.
Healthcare has been privatized for ages, and there has been some competition between different providers, insurance companies, some pharmaceutical companies and the like all looking to profit from delivery of a service that is supposed to work for the public good. However, despite the fact that we've done it for so long, treating services like healthcare as for profit industries has been one of the worst ideas we have ever embraced. While on the surface it seems like a good idea in that it is supposed to lower costs, save taxpayer dollars, stimulate innovation, etc... the reality is that for public services, there never has been or ever will be a truly free market, so all of the assumed benefits never materialize.
Using healthcare as an example, costs steadily rise, despite there being different providers in competition with one another. To help people cope with the increasing costs of healthcare, more taxpayer dollars are spent on healthcare services and pharmaceuticals. The innovation that is supposed to be driven by a desire to provide better and more efficient services in order to create profit focuses instead on treatments that may take symptoms away, but never seems to address the issue enough to provide a true cure. In many cases, that treatment becomes a large expense that a patient must pay for the rest of their lives. In some instances, such as using opioid based pain treatment, that treatment causes further issues and higher costs.
Certainly, this becomes "good business." It is a guaranteed money maker with a truly captive demographic.
Is it the best way to serve the public?
Literally everyone needs healthcare.
It is the definition of a public service for the general welfare of the people. It is a basic human right. When treated as such, as happens in other countries, research is driven by a desire to actually result in healthy, functioning people. The innovations do happen, and the economic benefit is shared by everyone in that they can now be more productive in other fields. Healthcare providers are still well compensated for their service. They also still enjoy the prestige earned by their position and career. The governments that act as the single payer insurance are able to negotiate lower costs for the pharmaceuticals and services provided. The communities that have this public service provided by their government prosper and thrive, thanks in no small part to the security and stability afforded them by not having to worry about the high cost of healthcare.
We can do this in the United States, and in so doing create a situation where people prosper better here. I have no doubt that with the lower costs, the stability of better health, and the security in knowing that healthcare, if needed, is provided, more businesses will thrive and be profitable.
So I disagree with Alex Azar's approach to addressing the increasing cost of healthcare for us. I disagree with the idea asserted by the fictional Omni Consumer Products, that "good business is where you find it"; with the idea that public services are best served by profit motivation. Public services should benefit the public, and are best served with that in mind.