The Illness Profit Industry and National Security

[Zeno Swijtink]

The Illness Profit Industry and National Security Elsevier
Stephan A.*Schwartz


The SchwartzReport tracks emerging trends that will affect the world, particularly the United States. For EXPLORE, it focuses on matters of health in the broadest sense of that term, including medical issues, changes in the biosphere, technology, and policy considerations, all of which will shape our culture and our lives.

“After a spell of two days in hospital following what amounts to a heart attack, I returned home and was shortly thereafter sent a document telling me my insurer refused to pay any of the $17,000+ bill.” My friend Daryl (I have changed his name to preserve his privacy), a highly sophisticated and notably brilliant writer, said all this to me in an e-mail when I asked him how he was doing. He went on. “This is larcenous and disgraceful behavior; I've been paying ever increasing monthly premiums for years, and it is beyond belief that the insurer should now refuse to meet its responsibilities.” Daryl had come here from another industrialized country where healthcare was considered a right; this was the first time he had asked anything of his insurer, and his disbelief was tinged with deep vexation.

“When my attorney wife called them to protest, she was told cheerfully that this notice had been sent out routinely ‘before the situation has even been assessed’ and hence to ignore it—for the moment. Then I got notified that a crucial medication I have had prescribed for some years was being disallowed even though my specialist wrote the requested authorization for it at the insurance company's demand.”

Daryl tells me he will have to think twice before seeking further treatment, even though he knows this may ultimately be more expensive and may result in the destabilization of his entire family's economy, with a cascading range of negative results.

If you are an American, you know several stories like this. They have happened to your friends, or to your family, or to you. If you are in a healthcare profession, you probably know dozens of them, at least some firsthand.

I want to use this common story to begin laying out another perspective. I want to begin by asserting that Daryl's situation arises not because the healthcare system is broken, but because we do not have a healthcare system in the United States. Instead, we have an illness profit industry, and the system that model imposes. And it is destroying the vitality of the United States.
Am I exaggerating for effect here?

In 2001, an unusual collaboration of the Harvard Medical School and the Harvard Law School discovered 1.458 million American families filed for bankruptcy. A research team led by David Himmelstein surveyed 1,771 personal bankruptcy filers in five federal courts and subsequently completed in-depth interviews with 931 of them, and published the results of the study in 2005 in the journal Health Affairs.1 Their report noted that “about half (the bankruptcies) cited medical causes, which indicates that 1.9-2.2 million Americans … experienced medical bankruptcy.”1 In a fully Dickensian twist, about 700,000 of those affected were children.

In addition to the gross numbers, there are other things about this study I find notable. It reveals how close to the edge many Americans are. The study of Himmelstein et al1 showed that “among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness.”1 This is not a crisis resulting from six figure debts, as it is often portrayed. Over three quarters of those who went bankrupt had insurance at the onset of illness. They lost their coverage during the course of their illness.

And this entire national story is not getting any better year-to-year. What is even worse—it is entirely predictable, and always has been.

The behavior of Daryl's insurance provider may seem morally reprehensible and medically unsound but no one should be surprised by it. After all, isn't this exactly what one would expect from an illness profit industry, where profit and shareholder value are the highest priorities? Daryl is a bad investment. And you may be as well, and there is no way a system predicated on profit as the highest priority is ever going to be any different.

One of the sure signs a system is working against the national interest is that it continues its destructive behavior even in a time of great stress, and that is exactly what we are seeing. In the midst of the worst financial environment since the Great Depression, as people are dropping from the insured ranks by the thousands, hospitals and pharmaceutical companies in April 2009 began raising drug prices. In a clear announcement of their priorities, and as but one example, Sprycel—a leading treatment for leukemia—was increased by more than 20% from what it had been a year earlier. As The Wall Street Journal reported, the profit illness industry has “been pushing through hefty price increases aimed at bolstering earnings, even as government and private insurers are struggling to rein in healthcare costs.”2

When the Harvard study was published in 2005, Quentin Young, MD, national coordinator of Physicians for a National Health Program, observed, “The paradox is that the costliest health system in the world performs so poorly. We waste one-third of every healthcare dollar on insurance bureaucracy and profits while two million people go bankrupt annually and we leave 45 million uninsured.”3 Today, in 2009, that number is in excess of 47 million.

And for all that money, do we get, as is so often claimed, “the best healthcare in the world”? Let's just consider two outcomes every one of us will experience—the antipodes of life—birth and death.

Infant mortality rates by country are given in Figure 1; it should be noted that they are usually taken as a measure of a nation's healthcare. Not very impressive. Singapore has 2.31 deaths per 1,000, the United States has 6.26. Infant mortality rates are clearly linked to socioeconomic status, with minorities having higher rates than whites. African Americans do worse, with a death rate that is nearly double that of whites—13.9 deaths compared with seven. Rates among some other ethnic minorities also tend to be higher: the infant mortality rate among Puerto Ricans is 8.2, and for Native Americans 9.1.


Figure 1.*Infant mortality rates by country. From CIA World Book.4

“Some of that is due to poverty but it doesn't track perfectly with poverty,” Dr Nancy Green, medical director for the March of Dimes, told ABC News. The “infant mortality rate among Central and South American immigrants, for example, is only 5.1,” she noted.6 Clearly some other factor—the potential for profit—is at play here.

Life expectancy is given in Figure 2. Not very impressive either. Japan, for all its cultural stresses and hard work, routinely allows it citizens more than four extra years of life (82.12 years) compared with their American counterparts (78.11 years).


Figure 2.*Life expectancy at birth by country. From CIA World Book.5

I could take half a dozen other outcome measures, most trending in the same way, and make these same points over and over. Clearly the problem is not technical or medical, it is cultural, arising from a set of values in which profit is placed ahead of life. But what exactly does that mean? Let me propose that we have not been looking at this issue in its fullness. We have not been asking the right question.

Once, walking through the architectural artistry of Louis Kahn's Salk Institute, Dr Jonas Salk—in one of those moments when I knew something important had just been said to me—observed, “The challenge, of course, is not the answer but asking the right question. It's always the question that matters.”

So here's a different question: What is the role of healthcare in national security?

Let me suggest that the answer is extraordinarily important to the future of the United States. Healthcare is as much a matter of national security as what we call our “defense budget.” National health—that is the health of the individuals who collectively make up our or any society—is as important to our national prosperity and functionality as a society as any military consideration.

Two years ago, in these pages, I wrote an essay entitled “The Neuron Strategy.”7 To restate its point: in a global economy a national society prospers in direct correlation to the degree that it allows, encourages, and equips each individual to express their potential in a compassionate life-affirming way. Stated in the baldest way: those countries that have the most neurons working for that society's well-being will be best positioned to make it through the vicissitudes of climate change and globalization that lie in the years before us.

Good health and good healthcare, thus, are national assets that increase a nation's functionality, giving it a much better chance to prosper. Viewed from this perspective, the illness profit industry model damages national security, because its priority is not national health but profit.

References*

1. Himmelstein*DU, Warren*E, Thorne*D, Woolhandler*S. Illness and injury as contributors to bankruptcy. Health Aff (Millwood). Jan-Jun 2005;(suppl Web exclusives):W5-63–W5-73.

2. Martinex*B, Johnson*A. Drug makers, hospitals raise prices. The Wall Street Journal Web site https://online.wsj.com/article/SB123...8959.htmlApril 15, 2009;Accessed April 15, 2009.

3. Medical bills leading cause of bankruptcy, Harvard study finds.
Consumeraffairs.comhttps://www.consumeraffairs.com/news04/2005/bankruptcy_study.htmlFebruary 3, 2005;Accessed February 3, 2005.

4. CIA World Book (Infant mortality rate). https://www.cia.gov/library/publicat...k.htmlAccessed 3 February 2009.

5. CIA The World Factbook (Life expectancy at birth). https://www.cia.gov/library/publicat...2.htmlAccessed 3 February 2009.

6. Lallanilla*M. U.S. babies die at higher rate (ABC News Web site). ABC News - ABC News 1, 2005;Accessed November 1, 2005.

7. Schwartz*S. The neuron strategy. Explore (NY). 2007;3:453–455. Full Text | Full-Text PDF (65 KB) | CrossRef
Stephan A. Schwartz is the editor of the daily Web publication The SchwartzReport (The Schwartz Report), which concentrates on trends that will shape the future, an area of research he has been working in since the mid-1960s. For over 35 years he has also been an active experimentalist doing research on the nature of consciousness, particularly remote viewing, healing, creativity, religious ecstasy, and meditation. He is the author of several books and numerous papers, technical reports, and general audience articles on these topics. He can be reached via e-mail at [email protected].