Commodification of Health Care and Universal Coverage

Film Review

Three major problems in the US health care system are cost, access to care, and coverage (Frontline, 2008). The commodifcation of health care is a major root cause of all of the above (Pellegrino, 1999). Rather than preventing health care problems, the industry focuses on treating symptoms and performing often unnecessary testing because this is where the profit lies—not in prevention (Goldhill, 2009). The industry puts profit first instead of people. Preventive health would go a long way to reducing many of the health problems seen today, such as obesity and heart disease, but the integrated manner of industry today is such that the sugar industry would suffer if the health care industry actually focused on getting people to reduce their sugar intake so as to lead healthier lives. Because all industries are essentially controlled by a small percentage of wealthy capitalists, the integration is purposeful and deliberate. The reason the problems of cost, access to care, and coverage have not been “fixed” in America is simply that the profit motive reigns supreme.

Other countries around the world have different systems in place, but they do not really solve the problem of cost. In the UK, health care is socialized—but taxes are higher there than in the US because someone still has to pay for care; and wait times for getting a procedure done are long, too. In Switzerland costs are comparable to what they are in the US, but in Spain they are much lower because there health care is “free” (but, again, taxes are high). In Japan it is no different: there the people have better health statistics than in the US, but they also spend three times as much time in hospitals getting tests and treatments (Frontline, 2008). To some, so much time in a hospital takes a toll on one’s quality of life, and that has to be measured as a cost, even if financially speaking the cost of care is lower there than in the US. Taiwan uses a smart card system in which the government pays for care, but the problem of funding is a serious one and it is unclear whether this approach is sustainable (Frontline, 2008). In Germany, there is universal health care, and costs are lower because care providers are paid much less than in the US (Frontline, 2008). But Germany also offers alternative forms of treatment such as homeopathy and spa treatment. What all of this means is that there is no clear indication that universal health care can fix the problems described above because it does not necessarily get to the root of the matter. The root of the problem is that there is too little emphasis on prevention and too much on treatment and testing. People are not taught to live healthy lives; they are taught to consume unhealthy products and health care providers push harmful drugs onto patients like they did in the lead-up to the opioid crisis. There is too little open dialogue about issues like COVID, where it has been shown by researchers that re-purposed drugs like Ivermectin can prevent the spread of the disease because relying on cheap solutions like that takes the profit out of the game. Health care should not be an industry like it is today. That is the major underlying issue, and it is not one that universal coverage will necessarily solve because it does not necessarily imply that preventive health care will be emphasized.

In the US, there is no real separation between business and state, so when the question is asked whether the government should provide for the health of the working people, it is essentially a question of whether the same people selling health care to the working people should be able to continue to do so at exorbitant rates and in unnecessary and often harmful ways. The wealthiest and largest firms control health care in the US: it is a large monopoly in which the biggest companies influence and set policy among regulators by contributing to the campaigns of legislators (Boushey, 2019). In the government of the US, law makers protect the interests of the top 1% and the top businesses. The government should not have to provide for the health of anyone; the market should be free and anti-trust regulations should be enforced so as to prevent monopolies. If the government is going to do anything, whether for workers or for non-workers, it should insist that health care providers emphasize preventive health: but this is not going to happen because if preventive health were practiced it would take the profits out of the industry, for people would be healthier and have less reason to seek out the services, treatments, tests and drugs that the industry has to sell to them.

The problem is not that government does too little in the US; it is that government does too much to serve the interests of the oligarchy (Boushey, 2019). This service perpetuates inequalities as it ensures that the wealthy class benefits at the expense of the lower classes. Private investment in health care could help to bring about innovative solutions to health care needs, improve access to care, reduce cost, and lower the need for coverage; but public funding is needed to spur on private investment, and public funding is hampered by the fact that the wealthiest firms and wealthiest individuals use tax loop holes to avoid paying what they otherwise ought to be required (Boushey, 2019). So the situation is not as simple as just saying that universal health care would solve all problems for workers or for non-workers. It is much more complicated than that.

As the film shows, different countries have erected different systems for how to deal with health care: Japan is unique for instance in that it bars insurers from turning down patients with pre-existing conditions and they are not allowed to make a profit (Frontline, 2008). But Japan is also unique in that its central bank—the Bank of Japan—is essentially the largest shareholder of Japan’s public market. The Bank of Japan is virtually propping up Japan’s economy, which is not a good indication of robust economic times and could be viewed as a problem in the bigger scheme of things. Economic sustainability is all the more problematic now that COVID lockdowns have become a norm. Japan is hosting the Olympic Games this summer, yet has barred spectators and sponsors are pulling out. This is going to be a substantial economic hit for Japan, and that is going to be felt by all classes.

The main idea behind the Frontline (2008) documentary is that nations can centrally plan their economies and their health care systems instead of allowing the free market to determine things. Even in the US there is no real free market, as anti-trust laws that should be enforced aren’t, which allows the big firms to merge and swallow up the smaller ones. Today, there are only a handful of large health care corporations that provide service to hundreds of millions. This is the very definition of a monopoly; it is no different from Standard Oil running the oil industry earlier in America’s history. This is an enormous problem, especially given the fact that health care has been commodified. The reality is that if the heath industry was actually concerned about people’s health, they would be out of business: people would be healthy and would not require all the tests, treatments and drugs. The health industry is not concerned with health; it is concerned with selling treatments, drugs, and tests. It is a profit-driven business, not a charity or even a trade at this point. A health care practitioner or provider that tries to recommend a procedure or approach to care that falls outside the established way of doing things will be harassed or fired or barred from practice.

Frontline (2008) does not really scratch the surface of these issues but only examines how centrally-controlled systems have approached health care. If one is only concerned about systems of control, the documentary might be of interest—but actual health care is much more than a process of centralization. The documentary makes the case that in countries like Japan and Switzerland, where insurance companies have been restricted from profiting on basic medical care, but this is a bit misleading. The reality is that the Swiss spend the most on healthcare because insurance is mandatory and insurance companies make money from offering supplementary insurance (SwissInfo, 2018). So when the Frontline (2008) documentary suggests that insurance companies are not making a profit, it is not the whole reality: they make a profit from their supplementary insurance offerings, which include more things that are not covered by the basic mandatory insurance. Supplementary insurance is a lucrative market in Switzerland and the Swiss are willing to pay because the costs of care are high as they are and they want to be covered just in case.