The current state of American healthcare


I'm not a medical expert. My science career ended in Mr. Maciel's high school biology class. I remember the basics, we're all made of cells and whales eat krill, but world governments aren't calling me to consult when the next outbreak of Ebola occurs. I don't purport to know what I'm talking about, but I did just watch a Grey's Anatomy marathon, so I feel confident I can handle a discussion on the complexities of our healthcare system.

Here's my medical prediction: whatever you may be sick from, human beings will figure out a cure. Of course you might be dead by the time we do, but we'll figure out something. We're good at that. And by 'we' I mean people much smarter than I am who actually went to school for science and stuff. For thousands of years humans have been figuring things out. Fire. Space travel. Tinder. And our figuring has been increasing exponentially. We've got more human brains on the job now than ever before thinking about things from toilet bowl night lights to artificial synapses. So whatever you're sick from, we'll get you that cure. I just hope you have the money to pay for it.

I may not know fancy doctoring, but twelve years as a police officer in New York City has taught me about human nature. And humans are motivated by incentives. The incentive to avoid death and suffering is called fear. The incentive to gather resources is called survival. When we gather more than our fair share of resources it's called greed. Humans are pretty good about restraining greed. We learn at an early age the value of sharing. Stable societies exist on principles of individual fairness, but individuals don't control pharmaceuticals. Corporations do. The days of Jonas Salk are over, modern medicines are researched and developed not by selfless individuals, but by selfish giant corporations. And corporations are incentivized by profits and motivated by greed.

At the risk of alienating a generation of Wall Street fans, greed isn't always good. Greed can be good. Greed is part of human nature. You're greedy. I'm greedy. We may show our greed in different ways, but its still present to some extent in all of us. Corporate greed propels invention, and invention works great for society. It brought us lots of fun things like railroads and Facebook and the Pet Rock. Usually the pricing of these new and exciting products is held in place by consumer demand. No matter how good a product might be, people will only pay a certain price. This is true with Big Macs and Mach 3 razors and Buicks; raise the price too much, people stop buying. But when it comes to healthcare, those primal incentives of fear and survival take over and normal consumer behavior no longer applies.

The healthcare industry is like the Zombie apocalypse…it's the perfect storm of fear and greed. The greed produces the supply. The desire to make profits is the incentive to invest in the development of new medicines. The fear produces the demand. People will pay limitless amounts to avoid suffering. This creates a totally inelastic demand curve.

"Drugs are typically non-discretionary and consumers are relatively price-insensitive." I didn't write this little gem. This came from a Pharma Bro slide presentation to investors. You're Snow White and you've just taken a bite of the poisoned apple. How much will you pay for the antidote? The wicked Step Queen knew the power of control over life and death. So too does the Pharma Bro. That's why he raised the price of HIV medicine by five thousand percent and got away with it. Greed can be good, but unchecked greed is always terrible. Unchecked greed leads to more Ferraris and beach houses for Pharma bros (yay!), but it also means increased pricing for the sick and dying (boo!) and the general commodification of the American healthcare system (super boo!).

Thank God that we live in the United States where we're protected by strict price controls on drug pricing. Wrong. There are no drug price controls in the United States, which means we have to rely on the generous nature of big pharma to set pricing, and we all know how generous large pharmaceutical companies can be.

But this is not a shared problem. This is an American problem. Dig out that shoebox under your bed and take a look at your passport. If it says United States of America on it, congratulations, you are subsidizing the rest of the world's health care industry. The research and development of most major pharmaceutical companies is funded by overcharging sick American consumers in an American market with no price controls and then releasing the same medicines to overseas price controlled markets at significantly cheaper prices.

Does that mean Americans are more afraid of death than the rest of the world? Is that why we're willing to pay more in America for life saving drugs? That's insanity. We stormed the beach of Normandy! We sent up a bunch of guys to divert that asteroid in Armageddon and beat the alien invasion in Independence Day and War of the Worlds. We're the home of the brave. We pay more in America because we don't have a choice. Lack of a price controls allows big pharma to set pricing, and with inelastic demand, we'll pay whatever they tell us to pay. So too would anyone.

There was a popular documentary a few years ago about how awesome the French healthcare system was. In France, the government set the prices of medicines. In the United States, large pharmaceutical companies set drug prices. Which do you think will be lower? Cancer will kill you just as fast in Pittsburgh as it will in Paris, but the sucker in Pittsburgh has to pay four times more to buy the medicine he needs to stop it from doing so.

Of course the French healthcare system is awesome, someone else is paying for it. When you swallow that pill, you're not paying for the 47 cents of ingredients that actually go into your body, you're paying for the hundreds of millions of dollars of research and development that went into that pill's creation. If you're swallowing that pill in France, you're doing it cheaper because of America.

America has opened a tab at the pharma bar and everyone else is drinking for free, but setting price controls isn't entirely the answer. It works for other countries, because American consumers pick up the research tab. Consider, though, if we all had limited pricing: profits would decrease, but so too would the rate of new innovation. I like being alive. And I want those pharmaceutical companies to be as motivated as possible to keep coming up with better ways to keep me and my friends going.

Jonas Salk took no patents for his polio vaccine. He believed public health to be a moral commitment. It is a moral commitment. And morally, we should all pay our fair share. It's an entirely complicated issue, but understanding the basic inequities of the international healthcare market is a great first step to developing a new system which spreads the costs fairly amongst us all and de-commodifies the American market.

Matthew B.J. Delaney published his first novel, Jinn, in 2003. Winner of the International Horror Guild Award, the novel was optioned for film by Touchstone Pictures, was featured as People magazine's Page-Turner of the Week, and received a Publishers Weekly Starred Review. Delaney received a bachelor's degree in economics from Dartmouth College and a master's in public administration from Harvard.

Following the attacks of September 11, 2001, he left a career in finance and moved from Boston to New York City to join the New York City Police Department. He has been a member of the NYPD for twelve years and has been assigned to precincts throughout Manhattan and the Bronx as well as within Police Headquarters and the Intelligence Division. He is currently a decorated special operations lieutenant serving in a Brooklyn violent crime suppression unit. He continues to write in his spare time.