Why it’s wrong to profit off of people when they’re sick
America’s Conversation About Healthcare Needs a Moral Reframe
Americans are fed up with the healthcare system in this country: except for a brief period during the COVID-19 pandemic, there have consistently been more Americans with a negative view of the healthcare system than a positive view since Gallup began tracking it in the early 2000s (Gallup). Majorities of Americans believe that the government has a responsibility to provide healthcare to its citizens (62%, Gallup) and support big structural reform to our healthcare system to make this a reality (53% support a national health plan, KFF).
Unfortunately, talking about healthcare feels difficult because the American healthcare system is complicated. As a result, the public debate around healthcare is often bogged down by technocratic jargon and complex policy proposals. Politicians and think tanks debate the merits of a “single payer” system or reforms to private health insurance. The Affordable Care Act (ACA) debate centered around policy questions involving the public option, the individual mandate, medicaid expansion, and the “three-legged stool.”
Politicians and companies use this technocratic veil to cloud the issues. Their policy speak makes it difficult for even the most informed Americans to engage in the conversation, and nearly impossible to foster a broad and inclusive public debate around healthcare. Engagement in this type of debate is the first step towards engaging the public in pushing for meaningful reform. Instead, these powerful people protect the status quo, enriching themselves while keeping us divided by using charged language like “death panels” and “socialized medicine.”
The irony is that what we want from our healthcare is simple. We don’t want to worry about reforming reimbursement models, complicated policy levers, and filling gaps in a patchwork coverage system. Of course, these policy questions are important because they are ultimately the path to change, so they have their time and place.
But the heart of the issue is straightforward. Across races, backgrounds, genders, and zip codes, Americans all want to live in a country where we know that when our loved ones get sick unexpectedly, we will be able to access that care without fearing the cost. We want to trust that when we need it, our healthcare system will be there for us without bankrupting us. In short, we want a healthcare system we can count on.
This couldn’t be further from the reality that for too long, CEOs of hospitals, big pharma, and insurance companies, as well as the politicians they lobby, have focused on maximizing their profits over optimizing our care. As a result, when our communities need medical care, it’s not just our health that is at risk, it’s everything. Hospitals and insurance companies rob us of our hard-earned financial security by bleeding us dry. They rob us of our peace of mind, as we worry about the unexpected hospital bill that could bankrupt our families, anxiously thinking: “Can we afford the ambulance? The unexpected hospital visit? An extended hospital stay?” Indeed, majorities of Americans (56%) are very or somewhat worried about being able to pay for healthcare in the event of a serious illness or accident (Gallup). Medical debt is the leading cause of bankruptcy, with each year seeing over 500,000 people file for bankruptcy due to medical expenses and more than $80 million in medical debt collections (AP). The greedy few running the profit-seeking healthcare industries are the reason why.
Beyond bankrupting us, these companies rob us of our time, forcing us to spend hours and hours on the phone fighting with insurance over approval for treatments and disputed claims when we should be focusing on caring for our loved ones. They rob us of the freedom to pursue new job and life opportunities when we can’t risk losing employer-provided coverage. On top of it all, they rob us of our very humanity when they treat us like another number or a problem to fix when all we want is to be seen and treated as a human being. These burdens are bad enough in the typical day-to-day, but when they make the sickness or tragic loss of a loved one even more difficult than it already is, they are intolerable. All this is because a small group of corrupt and wealthy companies exploit folks like you and me, when we are sick, to make profit. This is plain wrong.
There are economic arguments for why it’s wrong to profit off of people when they’re sick. Unlike other consumer goods, people can’t engage as rational consumers in healthcare. Supply and demand don’t function normally in healthcare–if the price of a lifesaving drug goes up, you don’t have the leverage of choosing to forgo buying it, because you need it no matter the price. If you have a heart attack, you don’t have the luxury of comparing prices with the hospital down the street. Even if you do have time to research costs for non-urgent care, the prices for medical services are opaque–hospitals often don’t share the prices ahead of time, and insurance companies negotiate rates that are difficult to track and maximize their own profits. As a result, a free market approach to healthcare leaves patients highly vulnerable.
While all of this is true, discussing healthcare doesn’t need to be this complicated. Americans deserve a healthcare system that puts people over profits rather than taking advantage of us when we are sick. Period.
We feel this on an instinctual level, deep in our bones. We tested this theory by asking our friends, neighbors, and colleagues what they thought about this framing, and it resonated with nearly 90% (26 out of 29 people said it completely or somewhat resonated during our focus groups). This was also clear in the response to last years’ killing of Brian Thompson, the CEO of United Healthcare, which sparked an outpouring of anger and despair. Americans–whether Indigenous, Black, Asian, white, or brown–spoke out to share heartbreaking stories of denials, financial devastation, delays in care, and deaths. Though triggered by this dramatic event, this fury wasn’t new–it was a manifestation of an outrage we have long felt but that has simmered just out of the public spotlight. The stories shared were organic and personal, not cold or detached. They were angry and full of grief, not cerebral or technical. This is what made them so powerful in uniting public sentiment. No matter where we’re from, most Americans can agree that we need to take care of each other when we’re sick, not exploit each other for personal gain.
The good news is that it doesn’t have to be this way. Countries that provide health care that people can count on share one thing in common: they don’t allow health insurance to be the kind of big business that it is in the United States. Insurance companies in our country say that we can count on them to protect us from exorbitant bills and financial ruin, when in reality medical bills are bankrupting us. They refuse to cover our bills and make it nearly impossible for us to get care at all. What’s more, they think they can get away with it by using their wealth and political influence to spread fear of change in the healthcare system and keep Americans divided. They aren’t protecting us. They’re selling us a lie.
Although they may like us to believe that they have all the power, the reality is that insurance companies, hospitals, and politicians all work for us. Health insurance companies depend on our money to survive. Hospitals and employers that cooperate with insurers need our labor to operate. Lawmakers that support insurance companies depend on our votes. These systems depend on our cooperation and we can leverage that power to take back control over our healthcare and demand a system that works for us. We have the power to change our future, but to wield this power, we have to come together and be willing to take action to bring about change.
The conversation about healthcare in America is overdue for a reframe. Solving complex questions of healthcare policy is important work, but it’s the domain of politicians and policy experts. You shouldn’t have to be an expert to engage in the public debate around healthcare. You just need to have a stance on this simple moral question: is it wrong to profit off of people when they are sick? This framing centers morality, humanity, and the experience of accessing care. This lowers the barrier to engaging in the conversation about healthcare in America–the first step towards bringing people together to take action and demand change. You don’t need to understand the nuances of different healthcare systems because this reframing of the debate around healthcare makes our choice clear: Do we continue to allow our communities to suffer at the hands of a small group of corrupt and wealthy insurance companies, or do we use our power to win a system of health care we can all count on?
When put this way, Americans won’t be divided–we’ll be united against corporations that exploit us. When put this way, Americans won’t be unsure what to think–we’ll be indignant about the status quo. When put this way, Americans won’t be paralyzed by jargon–we’ll be moved to take action to bring about real change. Together, we will stop a health insurance industry that prioritizes its profits over our lives and build the future we deserve.