During a discussion with a reader on healthcare, I was surprised to hear him say that he was fine with the commodification of healthcare as long as he got good service [https://sierracountycitizen.org/whos-the-fairest-of-them-all/#comments]. First, I don’t know how one judges “good service” in medical decisions. You can’t do that process over again to find if an alternative might have worked better. Being satisfied with a service doesn’t prove anything about the quality of that service or whether it can’t be better, just as complaints and gripes don’t prove anything.
We can only look at aggregated experiences rather than one-time experiences to judge better and worse healthcare systems overall. So, here is a Harvard Medical School report of a study published originally by the Journal of the American Medical Association showing that hospitals that have been bought by private equity companies in order to make money rather than provide better services give poorer service: What Happens When Private Equity Takes Over a Hospital | Harvard Medical School.
But then I thought that perhaps my talking about commodification is befuddling because it is not generally known what “commodification” means. We all know that commodities are things bought and sold. But the market is much more complicated than that because of the finance industry. Finance used to be about making money available to be useful. Someone has extra money, they put it in a bank, and the bank loans it out to someone who needs the money. Money gets something of value done, and finance helps create that value. That era is gone. Most of finance today does not do that. Most money in the US goes into and out of another activity, which is also called finance, and which produces nothing of value, and that is futures trading.
Here is how it works. A farmer is going to plant chiles in the spring. He contracts to sell green chiles three months later at say $1.00 a pound. But a few days later, someone trading commodities futures reads an article about loss of snow cover in the Rockies. He or she buys a futures contract in chiles for $1.20 a pound. The price is bid higher until late spring storms increase flows in the Rio Grande. The futures market on chiles drops down to $.90 a pound. Throughout the early summer, daily, the market shifts, up and down. Every morning, early, farmers in their kitchens or in their pickups are following the futures market on the radio (at least they did in my day). But at the end of the season, the farmer sells his chiles at $1.00 a pound according to the original contract.
A lot of money has changed hands because of the betting over chile prices, but overall, the gains match the losses. Futures trading is a zero-sum game, but some people have made a lot of money. What is important here for me is that no real work or production or actual use of a commodity has occurred. It is all finance. The money has not produced value, even though it has made some people wealthy (and given them a better life) while impoverishing others. Commodification means you make something available for futures trading.
So what happens to healthcare when it is commodified? Every aspect of healthcare is bought and sold on the market, doctors offices (my dentist retired and sold her business to a Texas conglomerate), hospitals, health insurance companies, the contracts you sign with insurance companies, the contracts they sign with health management companies, etc. Not only are these on the market, but futures contracts on the services and contracts are sold on the market. Here is a company that manages those future contracts: https://www.cmegroup.com/markets/equities/select-sectors/e-mini-health-care-select-sector.html .
Every aspect of healthcare is controlled by speculations on contracts that specify those aspects: the time you spend with your doctor, whether the doctor will or will not refer you to an expert, what level of care you get, your medications, and, of course, what you or your insurance company will pay. This situation, as we all know, is running full force with medications. Here is an interesting bulletin on futures trading of pharmaceutical contracts which I don’t understand but which is indicative of how complex healthcare contracts are in the world of commodified contract trading: https://www.opko.com/investors/news-events/press-releases/detail/501/opko-health-and-healthcare-royalty-enter-into-250-million-note-purchase-agreement-secured-by-ngenlas-profit-share-payments
Every study shows commodification of healthcare deteriorates care and service to patients and benefits the financial aspects of the owners. And that makes simple sense since if healthcare’s aim is to make a profit rather than make people healthy, it stands to reason that poorer service will result in more patients and increase profits.
It boggles my mind that any patient seeking care would think that commodification of healthcare is a good thing for the patient. Commodification of healthcare is the underlying reason why – to revert to the results of the recent Commonwealth Fund comparison of our and 9 other countries’ healthcare systems – we pay much more and get much less than patients in other countries.
I just got my bill for having some stitches taken out of my thumb. I could not get them taken out at the Sierra Vista Clinic and had to go to Emergency. The doctor’s charge was $269. Medicare (tax payers) paid $50. A contractual adjustment reduced the charge by $165. I had to pay $54. That is to pull out 4 threads. And, I haven’t gotten the hospital charges for using the Emergency Room. I’m sure it will be substantial. This was a huge waste of a specialist’s time (his contract with Sierra Vista brought him from Colorado) and the hospital’s space and equipment.
Of course, I’m happy to have the stitches out and happy to have it done neatly and quickly and politely, but, really, that is not the question. The question is why we, who do not benefit from the gambling of the wealthy financiers, should find it acceptable, even fine, that their desire to speculate with the profitability of healthcare creates for us – patients, doctors, and all healthcare providers alike — a costly, unequal, wasteful, impractical, frustrating, and idiotic healthcare system.
Amen to your article
A very good article by Mr.Yeh yet again. He certainly does his research. And it is a shame that the moneymen got into the healthcare business on every front. I am thinking that if I broke a bone I would go to a Western trained doctor. If I had a diagnosis of some dis ease, I would consult a naturopath or hit the net for research on herbs…. Western medicine seems to have fallen short in the ‘cure’ realm. Sorry to say that I have had my troubles caused by our pharmaceutical oriented healthcare practioners.
Naturopathy, too, is part of our health system and as such is also commoditized. In fact, it arose because of the market system.
Thank you for the interesting followup. Yes, I said that I am fine with the commodification of medical care as long as I get good service. I tried to make clear that I made sure that I would get good service by signing up for medicare part f and then segued into part g. One can only sign up when first signing up for medicare or a pre=existing condition physical is required. It is not cheap nor intended to be universal, but after my annual limit, there are no co-pays for me. I do not need a medical referral to see any medicare accepting physician in the country, even at Mayo Clinic or Johns Hopkins. My medicare co-insurance part g is with Mutual of Omaha and I am happy with them. I do my research and request appropriate care. Yes, like you, I also made money in the futures market, at least until Mr Corzine at MFGlobal used my and others sequestered funds to gamble on the euro which caused my account to freeze and my contracts were lost costing me tens of thousands of dollars. Mr Corzine received no significant punishment as he was one of the largest single campaign contributors to BHO. Still bitter about that, can you tell? Anyway, Making America Healthy Again should be what we all are seeking, not better medical coverage. As Mr Kennedy continues to show, the food and water are toxic which cause chronic health issues and the cost of medical and pharmaceutical coverage will continue to be whatever the traffic will bear. Being healthy and careful with your fingers means less medical care is needed. And no, even when I had both knees replaced, I didn’t go to seek medical help to pull the dozens of stitches and metal staples, the surgeon said it was ok for my wife to do it at home. It was fun. Make America Healthy Again!
I find it difficult to understand how America can be healthy without a healthcare system (not necessarily healthcare coverage) which serves Americans equitably and efficiently (relative to the patient’s health and not to monetary profit). Unless, of course, one ignores the very simple fact that medical advances over the past century provided us with healthy outcomes from our illnesses. Just this morning, the Guardian reported that the use of two DNA derived drugs can prevent lung cancer progression after two years (https://www.theguardian.com/society/article/2024/may/31/trial-results-for-new-lung-cancer-drug-are-off-the-charts-say-doctors) and a few months ago, another lung cancer treatment prevented lung cancer progression for five years ( https://www.theguardian.com/society/article/2024/may/31/trial-results-for-new-lung-cancer-drug-are-off-the-charts-say-doctors).
The “healthcare system” is what we must resort to when our diet, water, and air is substandard. True, putting profits ahead of health can do us no good, once we have resorted to pharmaceutically-based western medicine, but what we call healthcare now is hardly where we start, or should start.
Clean air, good water, and good food (whatever that is) would be nice, but while pollution does exacerbate health, I do think that the things that cause illness — viruses, bacteria, and fungi, without which there is no life at all, healthy or not — are not to be eliminated from water, air, and food or from our own bodies. I do note, also, that non-western medicine exist and have existed for thousands of years in order to treat illnesses which happen even where water, air, and food are “clean”; that is to say, illness exists and is a natural part of life and death. I don’t know of any non-western medicine which is not in great part also dependent on “pharmaceutical” products. It’s just a question of how effective any medicine is, whether western or non-western.
In the US, the practices that are called “non-western” are all part of our commodity system. So called “alternative medicine” is dominated by commodities. They exist in a system where anything can be commodified and, once commodified, can generate contracts, and once contracted, those contracts can be marketed as speculative instruments for investment. People who want to change the health system are going to have to change contract law, etc. to effect any change at all. Like the air we breathe, the cultural systems we operate in is ubiquitous and all mixed together in very complex ways.
Thank you for sharing both your research and conclusions.
https://www.theguardian.com/us-news/2024/oct/05/private-equity-healthcare-california-veto.
Thank you, Max, for this excellent article. The problems with our health care system are very deep. I had not paid enough attention to this particular aspect, and you are “right on the money” (no pun intended!) in this piece.
As a GUARDIAN reader you probably saw this:
https://www.theguardian.com/us-news/2024/sep/18/american-health-system-ranks-last?
Perhaps someday, you and I can sit down and discuss this large issue, including many aspects of health and health care, at length.
I much appreciate your work.
Best wishes,
Haruhuani Spruce, M.D.
I did see that Guardian article. It is a report on the Commonwealth Fund’s annual comparison of health systems, the one I summarized for Citizen readers in “Who’s the fairest of them all,” which I published a couple of weeks ago: https://sierracountycitizen.org/whos-the-fairest-of-them-all/.
https://x.com/martymakary/status/1842715823217254750?s=46&t=Ug65k2rxoJNE8t9kWp737g
We don’t need more medical care, we need to MAKE AMERICA HEALTHY AGAIN
I don’t know who the “we” are. The only people who don’t need to have available medical care when they are sick are people who can afford complete, gapless health insurance from private insurance companies. If you mean those well-off people by “we,” then I would agree with you. Though, I will point out that those people would not pay for that expensive insurance if they did not feel the need to have medical care in the future.
If you mean we the people of the US, then, it is a nonsensical assertion given the numbers of Americans that daily are seeking medical attention.
As for the second statement, I wonder when the “again” refers to. Here are two measures of the health of the nation as calculated by the National Center for Health Statistic:
https://www.cdc.gov/nchs/data-visualization/mortality-trends/index.htm#:~:text=These%20graphics%20of%20U.S.%20mortality,selected%20major%20causes%20of%20death.&text=Download%20a%20dataset%20in%20CSV,right%20side%20drop%2Ddown%20menu.
This graph shows that, except for the deaths of the First World War, life expectancy at birth has increased steadily from 1900 to 2018. That is a major indication that health is better now than at any time in the past. It also shows that the mortality rate has dropped steadily in the same 118 years, from 2,510.0 deaths per 100,000 people to 723.6 deaths per 100,000 people. That is quite an enormous drop (a 71.1% reduction) which was effected almost solely (not by an increase in clean air, water, and food but in spite of a deterioration of air, water, and food quality) by advances in medical science.
It seems that “again” points to something that never existed. Again, I refer you to the Commonwealth Fund’s annual report on our health system.
I am sorry, but we don’t seem to be speaking the same language. There is a need for health care such as my knee replacement which a result of my employment, which I knew were coming so I bought the insurance to cover them. Public health issues such as pandemics and disasters are also on the important list. I see no need for more taxpayer funded health care for chronic illness caused by poor health choices such as from diet, substance abuse or smoking. I am sorry, but I am not as Christian as you and am not my brother’s keeper so I believe they are responsible for their own poor health choices. No More Fudge Rounds.
https://www.youtube.com/watch?v=9Ug7udnfbcE
We do speak different languages. For example, I try to speak from the sources of my information, so that the discussion has a basis for readers such as yourself to check and respond to. You seem to speak your opinions as assertions without any indication of where those ideas come from, so that what you say is not discussable but is simply self-expression, which is nice for you but not really a form publicly discussable.
All my articles on the health system are on the health system. I don’t see where your idea of responsibility fits in. You yourself talked about making America healthy. Or are you saying some Americans are Americans and others are not because they are irresponsible, and you are only interested in the responsible ones, the real Americans, being healthy? The health system is the whole works or it is nothing.
As for responsibility itself, I don’t know how anyone can tell what is the cause of an illness, which is always accidental on a molecular, cellular level. Many smokers don’t get lung cancer, and many lung cancer occurs in non-smokers. You are telling me that a health system should sort that out before treatment? Be real.
It is also unreal to think that Americans all have the money to buy insurance for their needs, so instead of thinking in terms of irresponsible people, maybe you should talk about how to get people healthy.
And where is fentanyl treatment?
https://www.youtube.com/watch?v=nyem3gD6XN8
What about fentanyl???? This is what I mean when I agree that we are speaking different languages. The Citizen’s aim is public discourse. It is not a public bulletin board or a social media site, like Facebook. Discussion on this site has the form of public discourse, not just a publication of personal opinions, even if those opinions are about public issues. The discussion here is about the healthcare system in the country. Yes, for example, discussions about insurance as part of that system, how it affects treatments, how it affects access, etc., are pertinent to the discussion. But personal considerations of why or what type of insurance one buys are only part of the public discussion if they are brought to bear on the part insurance plays in national healthcare. They are not relevant otherwise. This kind of discussion involves hypothesis, proof, argumentation, citations, etc. It is the kind of discourse that makes a society democratic (which is not just a large group of individuals each voicing their own opinions — which is what our political discourse has tended to become more and more). Public discourse has to allow relationships between people. It cannot be just self-expression, which is a kind of stone wall.
Another example: you speak about insurance, but insurance is itself not healthcare. You can have all the insurance you want, as you say you have, but insurance insures payment, not care. I have already given my explanation of how markets on contracts determine every aspect of a doctor’s care. They are indentured by their contracts with whatever hospital or healthcare business they work for. So whether you can actually get an appointment with the doctor you want to see, how much time you are allotted for the visit, how seriously your condition has to be to get a referral; which specialist you are referred to, etc. are all determined by those contracts not by your insurance company. So, good luck with your insurance in getting healthcare. Your healthcare is still problematic. My wife recently went to her primary care doctor for her annual checkup. It took over two years to get in, after three cancellations. Her blood tests, done for an expected but cancelled appointment, was long outdated. The reason was that the doctor’s practice had been bought and the new company has a different computer system for the records. Patients’ records are partly in one system and partly in another. It takes the doctor twice as long to review a patient’s history. She can see many fewer patients a day. This is another result of how the system works as a for-profit system subject to investment interests.
And while on the subject of insurance, since you opine that irresponsible people don’t deserve help in paying for their medical treatment, what do you think insurance is if not a whole system which transfers money from those that don’t need it to those that do while profiting from that transfer? In healthcare, that means that insurance is the healthy paying for the treatment of the unhealthy. Yet, you say you don’t like that but like insurance. I don’t think you are thinking through what you say, and that is the very heart of public discourse: it should be thoughtful, not just an off the cuff remark.