Aetna and Mylan are model companies in a healthcare system that values corporate profits over human lives


Aetna and Mylan are model companies in a healthcare system that values corporate profits over human lives

Over the last few weeks, the decisions of two big healthcare companies have rattled many. First Aetna, an insurance company, announced it was pulling out of Obamacare health insurance marketplaces around the country, following the lead of UnitedHealthcare and Humana. Then Mylan, a drug company, announced it was raising the price of life-saving Epi-Pens, which save people from deadly allergy attacks, to $600 per pack, up from $100 in 2007. Politicians and pundits are responding with apparent shock, and twisting themselves into contortions trying to explain how the insurance and drug markets could be better managed. They are entirely missing the point.

Aetna and Mylan’s actions should surprise no one. These companies are doing precisely what they are designed to do: make money. In an interview with the The New York Times, Mylan CEO Heather Bresch was quoted explaining, “I am running a business. I am a for-profit business. I am not hiding from that.”

The larger health insurance and drug markets that Aetna and Mylan are part of are operating precisely as markets are supposed to. Markets facilitate voluntary exchanges between buyers and sellers, pricing goods and services at a “market price” that, by its very nature, prices many buyers out. The problem is that healthcare is not an optional commodity, but a fundamental human need. By letting markets apportion healthcare, this country’s policies deny care and basic dignity to millions of people.

The marketization of healthcare sets up a dynamic in which hospitals, drug companies, and medical device companies profit by marketing their products to induce demand and charging whatever they want for medical care. On the other side of the equation, insurance companies make money by bargaining for lower prices, raising people’s insurance premiums, raising deductibles and other out-of-pocket costs, and restricting people’s access to care through narrow networks and uncovered care. In both cases, these industries are in the midst of an epic merger frenzy to try to seize even more market power and profits.

The devastating human toll of marketized healthcare is most visible in the twin crises of costs and access. Healthcare costs and access remain an everyday struggle not only for the 27 million people who are still uninsured, but also for the millions more who have health insurance but still can’t get the care they need.

A trend toward ever-higher premiums and out-of-pocket costs is placing an impossible financial burden on poor and working people. Together with a trend toward narrow networks and the long-standing exclusion of critical forms of care from insurance coverage, these high costs limit people’s access to needed care.

This all hits immigrants, people of color, poor and working class people, and people with chronic diseases especially hard, but almost every family in this country has a story about someone who had to delay care or skip treatment or medicine altogether because they couldn’t afford market prices.

What’s behind these crises and behind the current kerfuffles over Aetna and Mylan?

The typical narratives we hear are that inadequate access to care is the natural order of things or that the markets work, but we’re just dealing with a few bad apples. Both of these claims are bunk.

Our all-too-familiar struggles to get and pay for healthcare are not the result of some natural law: they result from the policy choices made by elected officials, which make us pay far more than any other country in the world for a healthcare system that bars millions from access and throws people into debt.

While politicians and the media score quick points and ratings by pointing their fingers at Aetna and Mylan — focusing our attention on the profiteering of individual companies, whose raison d’être, after all, is to make money — it distracts us from the root cause of the problem: the market itself.

Market fundamentalism is a deeply destructive and deadly ideology. Some 45,000 people died in 2009 from lack of health insurance, and deaths are only part of the human toll. Even if that number has declined with Obamacare, the health insurance market still kills vastly more people than many other threats that loom large in the public consciousness. Market extremism is at least as big a threat to our health, safety, and wellbeing as any other form of ideological extremism.

All economic systems, public and private, must serve to meet our needs and uphold our values as a society. If they fail to meet our needs and live up to our values because they’re designed or run poorly, we must improve them. And if there is an inherent conflict in the system that prevents it from being able to meet our needs, as there is with health insurance, the only moral choice is to find a fundamentally different approach.

To address the twin crises of access and costs, we need to be clear about what’s needed: a healthcare system that guarantees that every single person has access to care and for which nobody ever has to pay more than they can afford. The good news is there’s a clear solution: universal, publicly financed healthcare. By making healthcare a public good that is provided cost-free to all who need it and paying for the system through public taxes instead of through private insurance, we would meet those two key requirements: universal access and economic justice. What’s more, we would also end profiteering by insurance companies, lower the overall cost of the healthcare system, and make sure that the companies and individuals who have the greatest ability to pay — and who profit the most from our people, land, and economy — pay the most back into the system.

But therein lies the political challenge: these changes would mean eliminating profiteering by the insurance industry and the tax havens of the 1%. Both groups profit immensely off of the current arrangement and stand in powerful opposition to change. Never mind that universal healthcare has a stellar record of success all over the world or that its promise to increase access, reduce health inequities, and lower system and individual costs has been studied and documented to exhaustion.

So powerful are the holds of market fundamentalism and Big Money on politics that, even after Bernie Sanders made universal healthcare a central part of his agenda and won nationwide support from millions, political and media elites still paint universal healthcare as politically impossible or even anti-American. Instead of being met with moral outrage, they’re met with a shrug.

It is easy to lay blame on politicians and the media and throw our hands up at the state of the world, but that’s too easy, and it’s not what the world needs. As I’ve written before, the change we need will only come when everyday people stand up and organize.

In just the last five years, we have seen enormous changes in public consciousness about the humanity and rights of LGBTQ people, state violence against Black people, and economic inequality. Meaningful policy changes are slowly following. None of these changes happened because of some law of the universe or divine intervention: they were brought about by groups of people organizing.

In the topsy-turvy political world that is 2016, there’s reason for a lot of hope. Bernie Sanders’ campaign and his commitment to universal healthcare won enormous support across the country. The parents of children who need Epi-Pens brought to light Mylan’s price gouging — hardly a unique practice in the drug industry — by organizing, transforming what they were experiencing as a private struggle into a public issue requiring action.

Most hopeful of all, groups including the Movement for Black Lives, Healthcare for the Homeless, Nuestro Texas, Healthcare NOW!, and the Healthcare Is a Human Right campaigns in Maine, Maryland, Pennsylvania, and Vermont (with whom I work) are challenging the grip of market fundamentalism and corporate profiteering on our healthcare. By putting people who are directly impacted by the cruelty of the marketized healthcare system at the forefront of change, they are proclaiming a vision that puts people, not profits, at the center of the healthcare system, and they are rolling up their sleeves to do the work of organizing. People are changing what’s politically possible.

Nobody can claim to foresee how the future of healthcare will unfold in this country, but there is a crack in America’s market-fundamentalist ideology, and Aetna’s and Mylan’s profiteering is opening it slightly wider. It’s up to all people of conscience to pry that crack wider by having conversations and taking action to put human beings and human outcomes at the center of our healthcare system and in all of our society.