The American healthcare system is failing. As the world enters its third year of the COVID-19 pandemic, society and governance globally have undergone radical transformations—transformations that appear to be only the tip of the proverbial iceberg. As a result of the screeching halt, the pandemic was able to bring society, business, and governance to, countries all around the world have been forced to reevaluate what was once considered standard practices, policies, and general day-to-day human affairs. However, the light of public scrutiny has not shone on any one sector as intensely as it has on healthcare systems around the world. Within the United States specifically, the utter failure of every arm of the healthcare system was exposed by the striking number of COVID cases and deaths, by far the most of any “Western” nation.
What’s more, the shortcomings in the American healthcare system that were exposed by the Covid-19 pandemic don’t simply end with the pandemic itself, but rather have broad implications for both the current and future prospects of general health within the United States as well as globally. In this transitory phase where all nations are attempting to begin a return to some semblance of normality, the United States, as well as the rest of the planet, are granted a unique opportunity; through the reevaluation of the failures of current political, economic, and health policies, and by further evaluating the successes of such policies in a select few nations, governments and institutions are given the opportunity to improve their own policies and ultimately the overall health and well-being of their people. Most specifically, countries like the United States are poised to confront the root cause of their healthcare systems’ total failure—the commodification of health. In this essay, I will first explore the ways in which the commodification of healthcare results in widespread and disturbing health disparities both within nations themselves, as well as between nations. Specifically, I will contrast the successes and failures of the healthcare systems between nations with universal single-payer healthcare systems and those without. Finally, I will conclude this essay by delving further into the policies of nations with universal single-payer healthcare systems in an attempt to parse together what makes for a good policy with respect to health.
Crucially, to understand the role the commodification of health plays in the establishment of health inequities and disparities, one must first understand the process of this commodification itself. The commodification of healthcare occurs when both the ideological and practical facets of a healthcare system operate on the basis of a for-profit business model aimed at profit maximization with little regard for the health outcomes of the newfound “consumers.” Moreover, the commodification of healthcare takes several forms at the level of both institutions as well as individuals, resulting in massive health disparities within nations that employ such methods. Taking the United States as a case study, nations first commodify healthcare at the individual and preventative level. According to a Harvard meta-analysis of research published in the BMJ Journal, eating a healthy diet costs an average of $1.50 more per day than the cost of maintaining an unhealthy diet (Dwyer, 2014). That amounts to roughly an additional $550 per year, a cost that places real constraints on the ability of low- and middle-income Americans to take agency in their own health by proactively engaging in healthy eating habits with the hopes of staving off future maladies (Dwyer, 2014).
By the same token, large corporations in the United States engage in an intense and consistent campaign to commodify healthcare at the individual level by commodifying fitness. Advertisement campaigns in essentially all major media outlets—whether that be by newspaper, magazine, television, radio, social media, or otherwise—are representative of an effort by wealthy capitalist business owners to profit off the health of individuals by charging exorbitant fees for trending fitness classes like spin, yoga, and CrossFit. As a result, many Americans yet again remain precluded from taking agency in their own health. It’s here that the evidence of a major health disparity within the United States begins to emerge, resulting from the aforementioned commodification. According to an article published by NPR in 2019 in response to research out of UCLA, the link between an individual’s socioeconomic status and their health is undeniable. The article asserts that while the overall health of the wealthiest Americans has remained relatively stagnant throughout the past several decades, “the health of the lowest income group is declining substantially over time,” and that “there has been a clear lack of progress on health equity during the past 25 years in the United States” (Nelson, 2019). Undeniably, the health-wealth connection is at the center of inequities and health disparities both nationally as well as globally, with high-income individuals enjoying disproportionately better health than those in the bottom income bracket, underscoring the role of healthcare commodification in such injustices.
Yet another way in which the commodification of healthcare presents itself is at the institutional level, which results in disparities and inequities both on the national and international levels. Continuing with the United States as a case study, the American government’s healthcare policy employs a mixed-use of several different models of insurance, with the most prevalent being the Bismarck Model. Under this system, health insurance is not guaranteed for all individuals, as each citizen is essentially left to their own devices to find healthcare coverage. Most commonly, healthcare is provided to citizens through their occupation, with many full-time employers offering health benefits through privatized health insurance companies. At the same time, according to the American Hospital Association, nearly a quarter of all hospitals in the United States operate as for-profit enterprises (Fast, 2022). This establishes in the United States a confluence of for-profit industries that compete for profit maximization by hiking rates and expenses on the individual while minimizing payout and accommodations. The business model upon which such organizations operate inevitably results in the commodification of health by way of the simple fact that under such a system health becomes a service that must be paid for, coming at strenuous costs.
On the other hand, there are numerous countries around the world that employ a system of healthcare entirely antagonistic to that of the United States. Taking Cuba as a counterexample to America, the healthcare system employed in that country follows the Beveridge Model. Under this model of healthcare, all citizens enjoy universal coverage with the government acting as the single-payer for all health expenditures, eliminating the presence of private insurance organizations. As a result of the nationalized healthcare system of a country like Cuba, the commodification of health becomes an impossibility because no single facet of the healthcare system is for-profit. The results of the implementation of such a system are astounding in terms of the health benefits it produces. Before delving into the data surrounding health outcomes, the value of security in healthcare cannot be understated. The fact that all citizens in Cuba enjoy healthcare at the expense of the government vastly improves the quality of life, with the added benefit of peace of mind. What’s more, the data on health outcomes in Cuba suggest further benefits to such a system.
According to data compiled by the World Bank, the average life expectancy in Cuba in the year 2019 is 78.8 years, just slightly higher than that of the United States which rests at 78.78 years (Life, 2019). While there may not appear to be a substantial difference in life expectance between Cubans and Americans, taking a further look into the health inequality within the United States paints a clearer picture. Information provided by the National Library of Medicine shows that Americans in the fifth percentile in terms of earnings have a less than 20% chance of surviving to the age of 90, while Americans in the 95th percentile maintain roughly a 50% chance of reaching the same age (Chetty, 2016). Moreover, the costs at which these health outcomes are achieved in Cuba and the United States are remarkably different. According to data compiled by the Kaiser Foundation, 19.7% of American GDP expenditure in the year 2020 was devoted to healthcare (Kurani, 2022), whereas the World Bank reports Cuba’s healthcare expenditure totaled only 11.34% of GDP in the year 2019 (Life, 2019).
Not only does the United States spend a significantly greater proportion of its GDP on healthcare compared to Cuba, only to achieve a slightly shorter life expectancy, but the Cuban government covers the healthcare costs of all citizens with that slim percent of its total GDP, which is suggestive of a general state of good health among the people of Cuba. On the contrary, the United States’ failure to employ the use of a single-payer universal healthcare system means it, therefore, does not cover the cost of the majority of America’s healthcare expenditures, and yet it still somehow manages to pay an even greater percentage of its GDP on healthcare than Cuba. Again, this is suggestive of a general standard of ill-health among Americans as evidenced by the fact that the small fraction of healthcare expenditures covered by the United States government surpasses that of the entire country of Cuba. Here, the health inequities and disparities that presented themselves so apparently within American society have proven to go beyond a national scale, exemplifying the existence of such health disparities on an international level between countries where health is universal and countries where health is commodified.
What, then, are the lessons that can be learned from the successes of universal single-payer healthcare systems around the world? Moreover, what makes for a good healthcare policy? The answer to this question is multifaceted, with a good healthcare system requiring a proper definition of health, comprehensive systems of healthcare, a policy that includes health in all sectors, social determinants and syndemic approaches to health, and effective health delivery, management, and financing. The first, and arguably most important of these criteria for a good healthcare system is the definition of health itself. After all, how can good healthcare policy exist if the definition of health adopted by a nation is faulty? As defined by the Constitution of the World Health Organization, health is a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (Sartorious, 2006). Such a definition is both comprehensive and works to cover all possible sources of maladies in an individual’s life. Therefore, as a result of its aptitude in defining health, this definition stands as one that nations around the world should strive to uphold. Unfortunately, however, most countries fail to live up to the standard set by the World Health Organization as a result of the commodification of health, social taboos that surround mental health, and lack of resources and distribution.
The next pillar of any good public health policy is the comprehensiveness of the system itself. A comprehensive healthcare system is one in which—relating back to the World Health Organization’s definition of health—mental, physical, social, and spiritual health are intertwined, and access to care in any one of these areas is straightforward and attainable. In other words, physical, mental, spiritual, and social health should be promoted through balanced lifestyles that reap the benefits of healthy eating, regular exercise, and active social and spiritual engagement. Beyond simply the scope of national healthcare, the global community at large must employ comprehensive strategies to promote health on such a scale. Especially in the wake of the COVID-19 pandemic, the importance of managing health on a global scale is paramount for preventing health inequities. Especially given the unequal distribution of finances and resources between nations, through the use of modern methods of communication and coordination global efforts to establish good health must become a central tool in fighting not only future pandemics but future epidemics of mental ill-health as well.
The third pillar of any good public health policy is the application of a “health in all sectors” approach to healthcare. Essentially, what this boils down to is analogous to the current push in many major industries to promote sustainable practices. However, while the focus on sustainability in business of recent years has largely revealed itself to be yet another marketing ploy to draw in customers, the health in all sectors approach to healthcare attempts to draw attention to health in all aspects of society from social life, to business, to education, and beyond. Circling back to the United States and the inequities of health that occur along income brackets, America is a prime example of a nation that does not employ such an approach to healthcare. Fast-food chains offer highly processed meals high in saturated fats and sugars at costs far below those of healthier options, pharmaceutical companies sell drugs at exorbitant prices with numerous side effects and even addictive qualities, and major employers such as Amazon and Walmart regularly subject their employees to working conditions that are by all standards unethical. Clearly, the United States refuses to employ a health-in-all-sectors approach to healthcare, again in favor of the commodification of health itself—an unfortunate circumstance given the fact that such a policy could enable countless individuals to lead lives of much greater quality.
The fourth pillar of any successful health policy is the implementation of social determinants of health in such a policy, as well as the application of the syndemic approach to healthcare. According to the American Office of Disease Prevention and Health Protection, social determinants of health are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (Social, 2022). Within this framework, the five key social determinants of health are economic stability, education access and quality, healthcare access and quality, the neighborhood and built environments, and social and community context (Social, 2022). What these determinants strive to achieve is a broad-reaching system of healthcare that, again, infiltrates all sectors of society to promote health and well-being by minimizing inequities. Moreover, the syndemic approach to healthcare attempts to take into account more than just human health, drawing into consideration elements of health like environmental degradation, global poverty, and other such factors. Through the implementation of both the syndemic approach to healthcare as well as social determinants of health, a global healthcare system may strive to not only root out health inequities in terms of infirmities and actual disease but also the social and environmental diseases that also actively plague our society.
The final pillar of a good health policy revolves around logistics, such as management, funding, and distribution. As in the case of some of the world’s most effective healthcare systems, like those of the United Kingdom and Cuba, their systems are financed by a single payer, with that financier being the government itself. By eliminating privatized hospitals and insurers, the commodification of healthcare can be brought to an end, decreasing overall health inequities both regionally and globally. Further, in terms of distribution, the healthcare systems of the United Kingdom and Cuba again both exemplify adequate means of distribution in that they apply universally to all citizens. Whereas the United States offers government-funded health insurance for individuals who qualify through special means, and for individuals who qualify based on their age, the ubiquitousness of healthcare systems in nations where they are publicly funded is one of the central reasons for their success. While the commodification of healthcare proves itself to be at the root of major inequities both regionally as well as globally, through the implementation of comprehensive and broad-sweeping public health policies and concepts the world can strive to achieve an existence in which healthcare is equitable and just.
Works Cited
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