Summary: The author of Sickening: How Big Pharma Broke American Health Care and How We Can Repair It trenchantly describes the fiscal and health damage done to the US from the medical-industrial complex. He calls for transcending ideologies and parties to fix the problems. We say, yes, let’s join in a middle way to provide all with health care and fund it collectively.
America’s Broken Health Care: Diagnosis and Prescription, Imprimis, A Publication of Hillsdale College, February 2023, by John Abramson
By 2019, prior to COVID, life expectancy in the U.S. had fallen relative to that in the other countries so much that 500,000 Americans were dying each year in excess of the death rates of the citizens of those other countries. To exclude poverty as a factor in these numbers, a study looked at the health of privileged Americans—specifically, white citizens living in counties that are in the top one percent and the top five percent in terms of income. This high-income population had better health outcomes than other U.S. citizens, but it still had worse outcomes than average citizens of the other developed countries ….
Now combine this with the fact that we in the U.S. are paying an enormous excess over those other countries on health care. In the U.S., we spend on average $12,914 per person per year on health care, whereas that figure in the other comparable countries is $6,125. …
Which means that our health care system is broken and needs fixing.
Prior to leaving office in 1961, President Eisenhower famously warned the nation about what he called the “military-industrial complex.” I suggest that we now have a medical-industrial complex that is sucking America’s wealth away from the other things that will make us healthier and create better lives for the American people. …
Big Pharma is comprised of for-profit companies. The job of for-profit companies is to maximize returns to their investors. Accusing drug companies of being greedy is like accusing zebras of having stripes. They are doing their job, and we’re not going to change them. So it is our job – not only doctors, but the American people as a whole – to insist on guardrails to ensure that the pharmaceutical industry serves, rather than harms, public health.
What is needed is very clear. First, we need to ensure that the evidence base of medicine is accurate and complete, which requires independent, transparent peer review. Second, we need to implement health technology assessment, so that we and our doctors know which drugs and devices are the most effective. Third, we need to control the price of brand name drugs.
This is not rocket science – so why doesn’t it happen? Largely because the greatest bipartisan agreement among our political leaders is that it is fine for them to accept large contributions from drug companies. Huge amounts of money flow about equally to Democrats and Republicans. This is why meaningful reform will require the formation of a coalition of Americans to demand action. And a plea I would make is that people on the conservative side who have an aversion to government and people on the progressive side who have an aversion to free markets come together with open minds to find a middle way to solve the problem of declining health and spiraling costs.
We need to transcend our ideologies – to think of the good for our country and its people on this issue. Neither the people who tend to the Republican side alone nor the people who tend to the Democratic side alone will be able to break up the medical-industrial complex that has a stranglehold on American health care. Instead of focusing on our disagreements, we need to focus on what we agree about – namely, that it would be better if Americans were healthier and didn’t spend over twice as much money (much of it to little or no benefit) on health care as citizens of other wealthy nations.
By Don McCanne, M.D.
The United States has the most expensive health care system with the poorest outcomes of all wealthy nations, and it seems to be due to ideological divisions in our preferences for conservative concepts of free markets in health care versus progressive concepts of government control of those markets.
Dr. Abramson suggests that “people on the conservative side who have an aversion to government and that people on the progressive side who have an aversion to free markets come together with open minds to find a middle way to solve the problem of declining health and spiraling costs.”
What if we sat aside concepts about government versus markets and agreed simply upon making health care available to everyone and agreeing to join together to fund that care? That seems to be an entry to a middle way as long as we don’t get hung up on labels of markets versus government. We’re all still the same people interacting together.
If we still feel a need to get into useless disputes, we can argue over horses, zebras and stripes.