What is the future of Healthcare in the US?
Universal Health Care is the next incremental step. The research is demonstrating that a socialized system of healthcare is the best choice both morally and economically. The challenge of defeating the entrenched corporate classes is for another discussion. Today we explore what type of healthcare we would design into the modern Progressive project. My argument will be structured around two core premise. High-quality Healthcare is a universal right that all humans should have access to and that the advancement of our medical technology, talent, and institutions is a very positive thing for humanity as a whole.
How expansive can we imagine? The core questions at the heart of the Progressive project for the future are always about the amount of access and agency we are creating for every individual. Exploring alternative visions requires deep imagination and the ability to think beyond the current regimes of thought within the United States. Solutions developed that exist within our present style of market economy and accepted ideas about the relation of property and contract will at best succeed at humanizing the existing arrangements, and at worst fail under the pressure of profit-seeking. Our best strategy moving forward is, to begin with, imagination, creating a clear vision that we can use to work backward to manifest the change we seek to create. As we discuss systemic alternatives, it is critical to understand that our legal institutions shaped everything that is and therefore can be reshaped into what will be.
Begin with questions
The dominant mode of thought among Progressive thinkers within the U.S. is a system of universalized care and access. H.R. 676 is the most comprehensive bill in front of Congress at the moment and is being significantly bolstered by the grassroots efforts of organizations like Health over Profit. There is a growing mandate for the program, the data is clear that is economically the best choice, and there are numerous intangible benefits that would positively impact Americans such as reduction in anxiety and fear about the future. These efforts and interests are vital to the Progressive project of today, but what lies beyond the present policy initiatives?
In a scenario where health is valued at a very high level of importance, we begin by building a framework for our imagining of an alternative future. For this exploratory exercise, we will start from a point in time when H.R. 676 passes in its current form – granting all citizens access to quality, free healthcare regardless of socio-economic status. Still, we are left with numerous questions in regards to the broader vision of systemic improvements. How can we accelerate the ability of medical professionals and organizations to experiment and innovate in their respective fields? What is the best way to open up access to the medical professions? Who are the future medical professionals and how do we best prepare them to succeed? How serious are we about advancing medical technologies? These questions go beyond access into a deepened agency for all participants to improve and refine the system so that healthcare becomes an industry of perpetual innovation.
When discussing institutional reformation, we must focus on the core of our problem when it comes to healthcare. The passage of H.R. 676 would provide a basis for all people to have access to health care but it would not remove money from the process entirely. A socialized model of access to health care will exist in perpetual conflict with a for-profit model of facilitation, experimentation, and innovation. Therefore we must explore both the present and the potential of our medical institutions.
At a recent Medicare for All information event, I heard an argument for a hybrid model of hospital care. The gentleman argued for a socialized bottom but including levels where those with the ability to pay for a higher level or quality of service could do so. This argument assumes that there is a real level of quality difference in the services and facilities offered, but data demonstrates that there is not.
A Harvard study of Medicare data on 4.8 million patients and 4,571 hospitals, 237 of which converted to a for-profit model showed no discernable difference of the quality or frequency of care offered to individuals. A separate study found that for-profit health care institutions did change what type of services they provided, choosing to focus on the most profitable services such as surgery while neglecting to advance less profitable avenues such as home health care. There is a direct correlation between whether the hospital is operating under a for-profit or non-profit model and the number of people requiring return visits which generate additional profits for the hospital but are not necessarily beneficial for the patient. Debunking the argument that a for-profit model is necessary for efficiency, a 2006 study by the Congressional Budget Office demonstrated that operating expenses in for-profit hospitals were only %0.5 lower than non-profit hospitals. The data supporting the fact that for-profit hospitals add no benefit to patients is overwhelming and could be an entire article on its own.
Understanding that for-profit facilities add no benefits we should seek to remove the profit incentive immediately. By legislating that all medical service institutions exist as non-profit entities, we open our institutions up to deeper levels of cooperation and access among the institutions funded initially by tax investment and perpetually by innovation.
Within our medical institutions, we could imagine a networked supply chain accessible to all organizations. Facilitated through a digital platform medical institutions of all sizes could coordinate ordering of materials on a national scale. Coordinating with a separate Progressive project of disseminating the most advanced modes of production our medical institutions could use Amazon.com-level logistics A.I. to determine the best routes for delivery, ordering schedules, and more. Although there would be costs in dedicating tax investment to develop this type of deepened connectivity, we would see a return on that investment in multiples based on cost reductions for our facilities due to collective bargaining. The result being cost reductions in the tax spend on medical care as a whole.
The networking of our medical institutions need not be limited to cost reduction. We could leverage our networked institutions to create a system where medical professionals could access all the position openings across all of the networked facilities. This same technology could be used to alert medical experts of when and where their talents were needed and even informs if emergencies were to arise. By deepening the connection between professionals, we give more agency to the participants to learn, explore, and offer their help. This would strengthen the ability of all medical practitioners to have access to the latest research, studies, and experiments. Deepened resource access for doctors means better care for patients – reaffirming our efforts for improving healthcare. Networking medical facilities and the practitioners to increase efficiencies and improve the quality of healthcare provided are just some examples of how a transformative vision for the medical industry and how we fund it could change our reality.
Innovation and Experimentation
For-profit companies now handle much of the innovation in medical devices, technologies, and medicine development. According to data from the National Science Foundation, private companies outspend the government in research funding on a 3:1 ratio. The Progressive project faces a unique challenge. We have learned through capitalism that challenge and conflict can give rise to innovation. But how do we diminish the conflict of profit-seeking advancement and an open system of health care that seeks to accelerate collectively and cooperatively? The answer is by not limiting ourselves to the current institutional arrangements.
No scenario we can imagine exists in a vacuum. If we can imagine a scenario where a suite of social protections that alleviate an individual’s concern about their access to health care, shelter, food, education, information, communication, and transportation – all of which are core elements of the Progressive project – we can begin to construct a scenario of alternative visions of the future of innovation in medicine. If we structured the healthcare market as an independent market with its own set of institutional arrangements that were applicable specifically within health organizations we could create a structure that would address the need for continuous innovation while removing the core focus of profit as a motivator. Such an institutional arrangement has the potential to exist in different variations of itself if and evolve when it becomes more optimal for society to do so.
Imagine an industry built from cooperative firms. Each one existing as an employee-owned organization and each organization having access to the others for collaborative purchasing to drive down costs. All firms within the industry would cooperate on the acquisition of resources and sharing of data but compete to create unique solutions to the challenges they were attempting to solve. Since everyone has access to the vital resources within a base of social protections, we can support a more intense competition fueled by a more focused and bountiful research and development budget provided via tax dollars and organizational structures that rank growth and research over the individual profits of a handful of owners. By deepening the connection between medical innovations firms and implementing a focused agenda of tax-funded research and development we give society a more profound stake in the direction of medical progress. In doing so, we can choose to regulate the profit structures of the products developed and sold within this market. Our goal is to enable those contributing to benefit from their efforts as well as giving the firm the opportunity to fund new experimentation and innovation while supporting a long-term vision of continued innovation in cooperation with society.
Changing the Structure
Under our current market structure, medical innovation companies compete as any other for-profit organization would – keeping research secret until patented and successful. This thought regime severally limits our collective potential for medical advancement. When it comes to life-saving treatments, technologies, and drugs they should be available to humanity at a price that helps support the people creating these solutions while at the same time driving more profits into further expansion and less into the hands of a few majority shareholders. Operating healthcare under our current market economy lessens our ability to create change and limits the imagination and intentions of those participating within the system. Instead, we should cast aside the dogmatic adherence to a single form of market and reimagine the requirements of the medical market.
Medical innovation organizations would be obligated to share their latest research and discoveries with competitors who in turn would be able to use the information to create new solutions. By providing all actors with access to the most recent data and innovations, we begin to accelerate medical research to heights not possible in our current market structure. When an organization successfully solves the problem we could elect to provide a bonus payment, some social capital reward, or other incentives to the winners. The successful firm would then lay out a plan for continued experimentation and their next objectives. We could experiment with the patent laws surrounding medical technologies as well – creating new legislative paradigms specific to medicine. Perhaps ensuring that only the organizations discovering the product can sell it while at the same time increasing the ability for competitors to improve the outcomes, even if only incrementally.
If society were funding multiple competitive organizations working on similar products eventually, we would see a scenario where an innovator arises, and others falter. In this scenario we let them fail. With the expansion of a vital suite of protections, deepened cooperation among firms, and a mandate for more federal facilitation of medical advancements, opportunity would be such that a person desiring to transfer between organizations to continue work on projects that excite them would be more accessible than ever. For example, if you were an engineer working for a company that was unable to succeed you would have the option to transfer to the organization that was successful and focused on continued innovation in the desired vertical. As the work is partially government sponsored and funded by growth more qualified researchers and professionals could be assimilated into the organizations without issue.
In this medical innovation scenario firms would more rapidly accelerate towards monopolies in their specific niche. These monopolies are unlikely to enter a state of permanence as we observe with the present market order because of the open access of information and technology to even the most fledgling firms. Some cooperative firms may accelerate to the point where their monopoly becomes one of talent – in this scenario we could create a separate market order. For organizations that develop products and services that become inseparable from society (think Google, Amazon, or Merck for a medical example) we could imagine new ways to integrate them into society. As a firm monopolizes its industry it acquires the additional social responsibility to share their depth of knowledge and talent with the world. Working in cooperation with academic experts and the state we develop systems of training open to all individuals interested in furthering the exploration of the specific field in question. Any person looking to change the focus of their transformational efforts in the world could enter the academy of one of the monopolizing firms and learn from the best minds and methods available to date. That individual could then choose to contribute to the organizations efforts or take the knowledge gained and apply it to an alternative vision of the future of the verticals of interest. The best firms become the best schools, creating a cycle of perpetual experimentation and innovation of our medical prowess. This type of expansive and self-perpetuating growth would fuel new opportunities within healthcare industry at all levels.
Helping our Healers
If our objective is to create a medical institution focused on cooperation, collaboration, and consistent innovation it is essential to have the right people on the bus. Past and present, medical field professionals are subjugated by our existing market order because of debt. The average medical student owes $207,000 at the time of graduation. Assuming a 30-year loan at 6% interest that financial burden becomes increased to a lifetime total of $446,785.05. If progress in the fields of medicine and health is what we desire, then the current order is unacceptable. Medical education should be structured in a manner to attract people with a genuine passion for healing, regardless of socioeconomic status. As a society, it is within our grasp to provide a pathway for those interested in pursuing medical education and profession to receive the highest quality training for free. Initial training could be structured through academia while ongoing and specialized training becomes a perpetual norm of the medical profession via a model institutionalized firms as described above. It is unreasonable to believe that we can shift the medical paradigm away from a profit-driven model when new doctors enter the field with almost half a million dollars in real debt.
The Progressive project extends beyond institutional reformation, drawing inspiration from our very core of what is and is not right. Medicine and health must be reimagined outside of the regime of profit. Until we expand the collective imagination about the value and necessity of high-quality medical education for all who seek it, we will be bound to the imagined regimes of men long dead.
Exporting health to the world
Upon realizing our vision of a reimagined market regime for the healthcare industry, we should do our best to export it to the world. If we want to revitalize the reputation and contributions of the United States to the world, then we should do so by proactively giving. I say “give” deliberately. The future is cooperative, not competitive. We give away medical technology, education, and access without expecting anything in return. In doing so, we usher in new ways of thinking more effectively than any marketing campaign could ever hope to do. As with all aspects of the Progressive project, our vision extends beyond the immediate, into the deeply connected future. A unified Earth is the best method for achieving stability, prosperity, and freedom for every individual. This vision is not within our immediate grasp, but if it is ever to begin, it will begin with a single nation taking the first proactive approach. The United States could be the medical innovation center of the world and in manifesting this vision join us deeper with our fellow humans across the globe.
The entire argument presented here is an expansion of one of the fundamental arguments of the Progressive project as suggested by Roberto Unger – there is no single or necessary form of market. What we have envisioned in this exploration is a new market specific to healthcare facilities and tool innovation, but the formula of a socialized bottom, cooperative-competitive middle, and institutionalized top could be applied to any other sector of our economy. Changes would be necessary to create the most optimal solution, but change is the natural order and all institutions going forward should be designed to accommodate transformation. This argument is just a single imagination that could be expanded in numerous other directions. Most importantly – our efforts transcend us. Our creativity is infinite, and we must spread that infinity with the world, sharing our efforts and innovations with those around us. Beyond Universal Healthcare lays the path towards a globally cooperative medical system designed and transformed for the collective global good.
 The Costs of a National Single-Payer Healthcare System by Charles Blahous https://www.mercatus.org/publications/federal-fiscal-policy/costs-national-single-payer-healthcare-system (Funded by the Koch Brothers)
 Public Support for Single Payer Health Care Grows Driven by Democrats Pew Research http://www.pewresearch.org/fact-tank/2017/06/23/public-support-for-single-payer-health-coverage-grows-driven-by-democrats/
 Medicare-for-all is cheaper by Ryan Cooper The Week https://theweek.com/articles/789640/medicareforall-cheaper
 Hospitals converting to for-profit status show better financial health, no loss in quality of care by Harvard School of Public Health https://www.hsph.harvard.edu/news/press-releases/hospitals-converting-to-for-profit-status-show-better-financial-health-no-loss-in-quality-of-care/
 Do different types of hospitals act differently? by Jill Horotwitz University of Michigan Law School https://www.documentcloud.org/documents/1146866-horwitz-study-on-for-profit-and-nonprofit.html
 For-profit hospitals correlated with higher readmission rates University of Illinois at Chicago https://www.sciencedaily.com/releases/2018/09/180918180456.htm
 Nonprofit Hospitals and the Provision of Community Benefits Congressional Budget Office http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/76xx/doc7695/12-06-nonprofit.pd
 Data check: U.S. government share of basic research funding falls below 50% by Jeffrey Mervis Science Magazine https://www.sciencemag.org/news/2017/03/data-check-us-government-share-basic-research-funding-falls-below-50
 Average Medical School Debt by Jeff Gitlen Lend EDU https://lendedu.com/blog/average-medical-school-debt/