Editorial page, Atlanta Journal-Constitution
June 20, 2004
Profit motive is health’s loss
In a country where capitalism is the state religion, it’s hard to get people to admit that the profit motive doesn’t improve every enterprise. Americans seem to think there is no problem that cannot be solved by some resourceful entrepreneur.
But we’re experiencing a crisis of faith in at least one area — health care. The soaring cost of hospitals and medicines suggests that capitalism is sometimes at odds with the common good.
Not many of us have the nerve to say that aloud yet. It’s heresy.
Besides, the last time any public figure made a serious effort to reform health care, the result was near excommunication. Hillary Clinton’s complex system of rules and regulations was easily caricatured by opponents, and the blowback was enough to keep any self-respecting politician away from health care for years. But in the coming decade, the soaring cost will force Congress and state legislatures to confront the problem.
We now have a health care system whose primary mission is not delivering
health care. Instead, insurance companies, pharmaceutical companies, medical device manufacturers and, in fact, many hospitals exist to make money. That’s their first priority, and also their second and third priority. The product they sell happens to be improved health. But they jack up the prices on the product and restrict it to those who can afford it.
In this enterprise, a little profit motive goes a long way. And in health care, it has gone too far.
Just take a look at what has happened recently to prices of some pharmaceuticals used by elderly patients. The prices shot up just as the new drug discount cards were released, ensuring that drug companies will earn just as much on products for ailments such as hypertension and arthritis as they did before. So those retirees who have struggled to pay for their medications will be no better off — even with discount cards. The prices of the 30 drugs used most often by retirees rose more than four times the rate of inflation from January 2003 to January 2004, according to consumer advocacy group Families USA.
In the United States, capitalism works as well as it does because businesses compete for customers. And there is usually a business willing to make any product available for a cheaper price. If a motorist can’t afford a Mercedes, he can buy a Mazda. If you can’t afford the $15,000 plasma TV, you can settle for the $500 cathode-ray tube model. But who wants to see the discount cancer doc?
Insurance companies have tried to hold down costs by reimbursing physicians at a standard rate for common procedures. But that has not kept health care costs from rising faster than the rate of inflation. Perhaps that’s because medicine is one of those mysterious enterprises where the average consumer can never be sophisticated enough to know what he’s actually buying. Most of us find a physician we like and do what he or she dictates. It’s simply not the same as buying a toaster or a dining room table. You don’t wait for a good sale to get your angioplasty.
There is also this difference with the average consumer product: Most Americans believe that access to doctors and hospitals is a right, not a privilege that comes with money. We don’t say that out loud either. Not yet. But federal regulations already guarantee treatment in case of an emergency. If you have pneumonia and need to see a doctor, a public hospital may not turn you away, even if you don’t have insurance.
But guaranteeing access to emergency room treatment has helped to push the cost of medicine even higher. It would be far cheaper to guarantee every American preventive care — regular check-ups for hypertension and diabetes, immunizations for school-age children, medications for routine illnesses such as ear infections.
As more and more working Americans find themselves without health insurance, our faith in the ability of capitalism to provide a fundamental asset of American life is being sorely tested. Sometime in the next decade, we’ll be forced to admit that government will have to step in and shore up the safety net by guaranteeing basic health care to all Americans.
The old-time religion will have some new hymns.
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Cynthia Tucker is the editorial page editor. Her column appears Sundays
and Wednesdays.