
Sick system
What the economy does to our health and how to change it

About Post-scarcity notes: As the staff of The Public Interest Network advocate for a cleaner, greener, healthier world, from time to time we’ll share observations on the larger challenge facing our network and our society: How do we shift the dominant paradigm — the very way in which we see and make sense of the world — from disposable to sustainable, from “never enough” to “enough,” from “making a living” to “living.” The views expressed in this space relate to our work, but do not necessarily represent the position of the network or its organizations.
Each year The Public Interest Network’s communications team attends two major gatherings of reporters, the Society of Environmental Journalists (SEJ) conference, held this year in Philadelphia, and the Association of Health Care Journalists (AHCJ) conference, which was held in New York in early June.
This was my first time at AHCJ and it was great to see the respect we have thanks to the work of Patricia Kelmar, PIRG’s Senior Director for Health Care Campaigns, and others who contribute to our health care, food safety, antibiotics and other programs. It was quite something to see the ABC News medical unit team, including medical correspondent Dr. Darien Sutton, producers and other backroom staff, make a beeline for the PIRG booth to chat with us.

What the conference highlighted for me is the sometimes mind-boggling complexity of U.S. healthcare. In panel discussions and informal conversations, reporters grappled with the details of how fees, drug prices, insurance policies, businesses and state and federal laws work in the healthcare world. Groups huddled in corridors trying to collectively figure out the fine details of a certain fee or policy.
As one panelist pointed out in a discussion about dementia care, if healthcare reporters have a hard time understanding this system, what chance do the rest of us — let alone people with cognitive impairment conditions — have when trying to access the care we need?
This complexity can also make it hard to figure out exactly why certain things are happening.
Take, for example, a topic many people mentioned at the conference: Pharmacy Benefit Managers (PBMs), who have been around since the 1950s. A recent New York Times investigation has shown their role in increasing drug prices. As the authors, Rebecca Robbins and Reed Abelson, put it:
There is another collection of powerful forces that often escape attention, because they operate in the bowels of the health care system and cloak themselves in such opacity and complexity that many people don’t even realize they exist.
They are called pharmacy benefit managers. And they are driving up drug costs for millions of people, employers and the government.
The same NYT piece also described the evolution of PBMs:
The modern P.B.M. emerged in 2018. The giant health insurers Aetna and Cigna were trying to achieve the growth demanded by Wall Street. They sought to merge with the P.B.M.s, whose profits were soaring. Aetna and CVS combined. Cigna bought Express Scripts. (UnitedHealth had built its own P.B.M.)
It would turn out to be a seminal moment, one that would rapidly and radically change the American health care system by further shifting power into the hands of giant conglomerates and away from employers and patients.
Health care in a post-scarcity world
All this got me thinking during the conference about health care and post-scarcity.
Today, health care employs more Americans than any other industry, except for professional and business services (it’s not far behind). In former industrial cities such as Pittsburgh and Detroit, ‘pink collar’ work in healthcare has replaced ‘blue collar’ work in factories.
It might seem strange that we have such a giant healthcare industry when we’ve solved many of the basic health issues that society faced just a handful of generations ago. The U.S. Centers for Disease Control and Prevention estimated that public health advances added 25 out of the 30 years that the average lifespan increased in the United States over the 20th century.
But the growth-at-all-costs, hyper-consumerist economy has created new ways to make us sick, whether it’s physical maladies resulting from exposure to PFAS and other toxics, air pollution and water pollution, or the anxiety and depression that have increased in modern life. At the same time, this societal model creates a financial incentive to keep us buying overpriced pills, products, treatments and health care services. The shelves of Walgreens and CVS stores groan with a dizzying range of health-related products (compared with the simplicity of dictums for a healthy life such as “Eat food. Not too Much. Mostly plants.”) Private equity investors are increasing health care prices by buying hospitals and physician practices and then seeking to maximize payouts to their shareholders.
With a system so dysfunctional, it’s no wonder our per capita health expenditures now surpass $10,000 per person annually.
An alternative future
If we lived in a society more in line with the post-scarcity vision, what might health care look like?
First, it would mean market constraints on pricing and billing to bring down out-of-pocket costs for patients. It would mean people being able to access preventive services, usually cheaper than treatment, without unexpected fees and bills.
More broadly, I think health care would become not just something that happens when you enter a hospital or visit a doctor, but something embedded in our daily lives.
Health care is clean air and water free from toxic pollution. It’s toxic-free food and products. It’s accessible and protected green and wild spaces for walking, playing and relaxing. It’s less work and retail therapy and more time for exercise, community and making healthy food.
If we had much more of this in our lives, it would surely reduce rates of many conditions, from mental illness to cancer. It would mean we would need to visit and be treated by healthcare professionals less frequently, or use health care industry products less often.
This might mean a smaller, more efficient and more localized health care system — an industry easier for both the government to regulate and the consumer to navigate.
Getting there requires the kind of unglamorous, consistent work that, over decades, helped add those 25 years to average life expectancy in the U.S. That’s what PIRG and many others, such as veteran health advocate Trudy Lieberman, who stopped at the PIRG booth to talk with us at AHCJ, have been doing since the 1970s.
I left AHCJ with added pride in our work tackling today’s health problems. Who knows what profound, positive changes we might achieve in the next 50 years?
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Authors
Jon Maunder
Media Relations Specialist, The Public Interest Network
Jon works to elevate The Public Interest Network’s campaigns in the media. In his previous work as a communications director in book publishing, Jon collaborated with many authors focused on social change and the environment. He grew up close to Dartmoor National Park in Devon, England, and loved to climb Haytor Rocks for the panoramic views. In 2021, he spent three weeks traveling around the U.S. on Amtrak trains, witnessing the country’s incredible natural beauty. Jon lives in Chicago, where he likes playing soccer, eating party cut pizza, getting more library books than he can read, and walking around Montrose Point Bird Sanctuary by Lake Michigan.