Healthcare and Capitalism - Business Lens

All right, now its time to go back to my scheduled program.

For those of you that might not be familiar with the term epatient, you are not alone. Many have bestowed the title of epatient on me for the last 10 years and I’m still not sure I know what it means. The most common definition would be engaged, enraged, empathetic, electronic, or educated patient. For the purpose of this blog post, I’m going to pretend I’m an economist patient.

As a chronic pain patient, an article titled “Profits over patients. How a Hospital Chain Used a Poor Neighborhood to Turn Huge Profits” hurts the heart and brain. Any healthcare system should be built around the mantra of patients over profits. Yes, the dream and motivation of profits is why I’m writing this on a very amazing laptop from Apple, have a couple of pairs of kick ass skis in my garage, and is the reason I drove to the coffee shop in a nice SUV and did not have to ride a horse or walk to get here. However, the pursuit of profits is the primary reason we now have forest fire seasons instead of a fire every couple of years, probably the reason Boise set another record for the most days over 100 degrees in August (climate change), and the reason why every human on the planet most likely has some foreign chemical in their DNA related to manufacturing. In addition, how many millions have lost their jobs and in turn their houses, food, and basic quality of life due to the pursuit of profits. For some reason, our social capitalism says “profits over X” is just because the desire to own cool toys and items is morally sound.

However, truth be told, the sentence “How a Hospital Chain Used a Poor Neighborhood to Turn Huge Profits” is the main reason for this post. Under any humanist lens, this is just wrong and more than likely is closer to being gross than only wrong. By any political, economic, financial, or social definition of “poor neighborhood”, these are humans that are struggling to make rent each month, probably have to choose between food or healthcare, or definitely have to choose between rent and meds on a constant basis. I have to assume since I have not spent much time in that part of the United States. These are humans that live paycheck to paycheck when they can; otherwise they live paycheck to credit card monthly payment or often called credit card roulette. For a not for profit hospital of all places to use this group to turn huge profits, not just profit, but huge profit, should be considered a significant symptom of a system that is sick.

Now, my second degree is in accounting. That means I have a host of economic and business classes trapped in my head. For some reason, this knowledge decided to jump into the conversation and play “devils advocate” to my epatient advocate pain. The fundamental reward and indication that of both our economic and social capitalist system is working efficiently and correctly is profits, actually huge profits. Capitalism defines successful innovation by the pursuit and obtaining profits from new or untraditional groups, basically people that don’t have excess income to spend on items that our culture has produced access too. So I have to ask, would I have the same gross feeling if the headline were “local business used a poor neighborhood to turn huge profits” or would I be intrigued because that is what business is supposed to do? I like to believe I would still have the same gross feeling but if I’m completely honest, at least initially, I would probably be more intrigued and would want to know how the local business accomplished such a feat.

Let me see if I can use more of a personal example. I do not live in a “poor neighborhood”. My neighborhood would probably be best described as the middle class dream. It is relatively new; I think my house is only 8 or 9 years old. In fairness, the main reason I was able to afford it was because I won it in a HUD auction. Actually, I came in second in the auction but the person who won couldn’t come up with the financing in time so they gave it to me. At signing I had already earned $2,000 in equity because of how the auction worked out. Since I have bought it the assessed value as increased roughly 300%.

As a government employee, my wage is lower than the average market rate for a similar position. Basically all government employee wages are. To compensate I do have great benefits and relative job security. I fully admit, I have a certain measure of privilege because of this which is generally not found in “poor neighborhoods”.

Now that I have shared more about my situation, here is my personal example. Due to some recent changes in my rheumatoid arthritis my rheumatologist has prescribed the biologic Enbrel. For simplicity, and the fact it is on Enbrel’s website, the price for this biologic is roughly $2,000 a shot. My doctor is prescribing one shot a week. If you do the math ($2,000 x 52 weeks a year) my cost before insurance and copay assistance is $104,000 a year. Now if I took my government income, savings, and small stock portfolio to a car dealership and asked for a $104,000 Jeep Wrangler they would laugh me off the lot. There is absolutely no business, economic, or social capitalist justification for me to have access to anything that costs $104,000 a year. However, since I have some measure of privilege I’ve been approved for this medication.

If you look at my story through a humanist lens, it would probably be considered a success story. I’m able to obtain access to a medication that is widely considered one of the best in controlling rheumatoid arthritis, which is considered a success in healthcare. If it works my quality of life will rise. Although I still need to read about my copay assistance, chances are good I wouldn’t have to change my current lifestyle in order or obtain this medication. That said, by any business, economic, or financial lens, I should not be able to this medication. My income and savings do not support having access to something that costs more a year than my entire house did.

On a high level, the federal drug rebate program the hospital is taking advantage of was designed to ensure that from a humanist lens, humans in “poor neighborhoods” will have access to the Enbrel’s of the world. This is a good thing. Next to education, good and stable health is probably the best thing to combat “poor”. From a business, economic, or financial lens, a business entity (regardless if its not for profit or profit base) taking advantage of a government program which was designed to ensure access to needed drugs is what the ultimate goal was. In theory, in order to obtain their not for profit status, the hospital will reinvest the “huge profits” back into their system which will help ensure more humans can get access to meds or as importantly, won’t have to worry about losing access to life sustaining meds. So from a corporate or social capitalist perspective, what the hospital did is a win win for all involved. Any entity taking advantage of an opportunity presented is supposed to be celebrated, not demonized in our culture.

So what is ultimately my point of these ramblings? I’m not entirely sure. All I know is my quality of life is ultimately dependent on a healthcare system that at one time might have been designed with good intentions but has evolved into and based on fragmented economic theory at best combined with a desire to do good with said good being measured in the amount a profits the “business of healthcare” can create. Epatients and human centered designers know that our healthcare system is fragmented which leads to a lower quality of life for all. I guess I’m trying to illustrate just how fragmented our system has become by taking a look at this New York Time’s story through several different lenses. It is bad enough that I have to live a life in chronic pain; surely we can design a better system that doesn’t create more pain because of its business practices. Healing should be my only job, but right now trying to navigate this fragmented system has become my primary job and healing comes second.