In a world where advanced healthcare has not only been plausible, but widely available for decades, one would think that with time, healthcare would become better, easier to access, and if not free, very close to free.  Certainly, one would think this to be true of all resources that we need to survive.  Life should be getting easier with time, not harder.

We all know, however, that this is fundamentally not what has happened.  Instead, the United States, the wealthiest country in the world, has proven itself unable to provide its citizens dignified livelihoods, even when it comes to the most basic necessities. 

This has become abundantly clear with the country’s healthcare system.

The statistics speak for themselves:

• According to Time Magazine, about 1 in 3 gofundme campaignsare for medical expenses. 
• Almost 13.7 percent of Americanshave no health insurance.  While employers in the United States who have at least fifty employees must offer some sort of healthcare plan to their full-time employees, many working people simply find the plans offered unaffordable and go without.  And while the Affordable Care Act has ultimately lowered the number of Americans with no health insurance, the number of underinsured has increased significantly.  In 2018, 35 percentof adult Americans reported forgoing a recommended health service in order to save money.
• In the United States, the top reason for financial bankruptcyis the inability to pay medical bills.
• About half of cancer patientsin the United States go through their life savings within two years to pay for related expenses. 
• Even ambulance ridesand having a childin the United States often cost thousands, if not tens of thousands, of dollars.

Certainly, the situation has angered many people, and has become a key issue in the upcoming 2020 election.

While many now call for a single-payer system in the United States, there are many self-professed “progressives” such as Kamala Harris and Pete Buttigieg that argue a single-payer system would eliminate choice for Americans.

Such an argument for “choice” supposes that the private model provides the Americans some level of agency over their decisions, when in fact there is none.  If one is fortunate enough to have a job that provides healthcare, they are largely beholden to the plans the employer has chosen.  (Of course, this means that they are also more entrapped by their situation of employment, as leaving their work would mean also leaving their source of healthcare coverage). 

Many of these employer-based plans, however, have worsened significantly in recent years.  For example, many employer-based insurance plans have overwhelmingly high deductibles.  Many Americans who have health insurance, as a result, often avoid seeking medical attention when they are ill because they know that their insurance will only kick in after significant spending.  Such a transition to high-deductible plans occurred largely after the 2008 financial crisis, when many employers opted to offer their employees the cheapest healthcare plans possible to streamline costs.  Now, 39 percent of employersoffer only high deductible plans (up from 9 percent in 2009):  half of American workersnow have a plan that comes with at least a S1,000 deductible per individual. 

In other words, these new plans have been adopted because they are cheap for employers, and expensive for employees. 

As such, it comes as no surprise that the modern crisis in care intersects with a crisis of employment: just as employers want cheap health-care plans, they ultimately want cheap labor.  As the data suggests, they have largely gotten their way.  Recently, it was reported that 44 percent of Americans work low-wage jobsthat pay a median of 18,000 USD per year.  Many of these jobs, especially service jobs, have unpredictable hours and limited benefits, especially when it comes to medical and dental care.  As a result, it is unsurprising that 78 percent of Americans live paycheck to paycheck, having little to no safety netto cover for potential medical emergencies that could arise.

All the while, health care insurance provider’s profits are soaring, and it’s not uncommon for CEOs in the healthcare industry to rake in tens of millionsevery year.  The pharmaceutical industry is also taking in significant profits, in part through exorbitant price increases for many common drugs.  The skyrocketing price of insulin (on average costing Americans with diabetes about $450 per month), for example, has led to about half of diabeticsreporting that they’ve skipped doses necessary to live, even though the way the drug is being produced has not fundamentally changed.  Overall, healthcare is becoming much more expensive: over the last decade, healthcare costs increased about twice as much as wages.

In a time of increasing precariousness, it is crucial to understand that the crisis of healthcare is not an accident.  It is not a crisis that exists simply because there are evil people who will do anything to make a profit.

Rather, the role of providing healthcare has been given to entities (i.e. health insurance providers, pharmaceutical companies, etc.) that have an inherent conflict of interest.  In the case of health care insurance providers, for example, every penny they use to pay for our doctor’s visits and emergencies, after all, could have gone to them. Similarly, in the case of pharmaceutical companies, there is an audience of consumers (the general public) that has little choice but to buy its products, no matter how expensive they become.  To do otherwise is to die --- and plenty of people are dying.  A 2009 study by the American Journal of Public Health concluded up to 45,000 deaths per yearin the United States could be traced to a lack of health coverage.

This is the conflict of interest at the heart of the system, and it is a lethal conflict of interest that only knows how to destroy.  It has no humanity, morality, or rationality outside its need to generate profit.

Perhaps Martin Shkreli said it best when asked why he was raising the price of darapim, a drug used to treat HIV, from $13.50 per pill to $750 per pill overnight, famously saying “I think profits are a great thing.”  While Shkreli may be particularly contemptible, he simply is admitting the open secret as to why even the most basic healthcare is often so inaccessible:  the state of healthcare in the United States is abysmal because it is profitable, and profitable because it is abysmal. 

If any progress will be made, it is because we will have stopped appealing to morality in a place it doesn’t exist and have instead started standing up for ourselves in a material manner.