Sunday, June 2, 2013

Healthcare shenanigans in the US

Recently my wife told me something she'd heard about the links between Angelina Jolie's double mastectomy and a private company's patent on the genes she got tested for.  I could hardly believe that a company was able to patent a gene that all human beings have one or another allele of.  I mean, up until now the gene patenting I've known of had to do with inserting a given gene into a new organism--the type of genetic engineering that many ag seed companies have gotten into over the past few decades.  While in the case of those seed companies I don't like the paradigm or implications of their patenting genes, at least there is a certain internal logic.  If you find a gene for glyphosate or imazypyr resistance in a soybean plant, the only way it got there is through the use of a patented technology.  But in my limited understanding of the "Angelina Jolie gene", as I'm calling it, the companies are patenting either the naturally-occuring gene itself, or the detection thereof.  This is not a case of a company inventing something new and useful that needs the protection of a patent, but rather of a rent-seeking exclusive claim on a gene that no one but God invented.  On top of that, this gene happens to have a lot of importance for human health and general societal well-being, and I'm willing to bet that some part of the research that went into "discovering" the gene was publicly funded.

This is part of a larger trend in US business that worries me greatly for our economic future.  It seems that we as a society and economic system have entered some late-stage, near-collapse decadence, a la Roman latifundia agriculture towards the end of the empire.  Companies increasingly resort to appropriating public goods, and then acting as if they have created value as opposed to just grabbing something for themselves that was already out there and valuable.  This is most evident when a company privatizes public services like potable water or parking meter revenues.  In these cases public goods are usually sold off at a laughable price, and then the privatizing company immediately jumps up the valuation of the company to its real level, or even beyond what it's really worth.  This is not value creation but rather a rent-seeking enclosure of the commons.  The same logic operates in a different way when a company outsources key functions to a poor country and then classifies its savings in labor costs as increasing worker productivity, as if a US worker had suddenly become more efficient as opposed to simply being replaced by a hapless, non-unionized Bangladeshi.  Outsourcing isn't a creation of value but rather a siphoning upwards of resources.

Returning to the Jolie case and to healthcare in general, here is another article that discusses the high, arbitrary prices in the US healthcare system.  It is a confirmation of the widely-held suspicion that private healthcare providers aren't pricing their services on a real market model, but rather based on a rent-seeking, extractive model of squeezing consumers and the State for as much as we're worth, with no correlation to real value of services provided.  In Colombia the government is seriously considering shutting down the private health insurers and clinics for the same abuses, though the Colombian health providers are much less shameless than their US counterparts.

It seems that private healthcare is a way to ensure that the public will be bilked by unscrupulous profiteers manipulating a captive market.  An HMO can't claim that your yearly checkup or your eye exam or your dose of antibiotics is any more efficient or smarter or better thanks to the dynamics of the free market.  Most of healthcare is basic, routine procedures that any more or less qualified doctor can perform, and if the profit motive were removed (as it is in a public system), these services would be cheaper.  Ditto for the simple administrative services necessary to run a hospital or clinic--the snotty, unreliably competent clerks and receptionists at a typical private healthcare provider would do no better or worse of a job working for a public master.  So the private sector doesn't have much to offer in terms of improving service or price.  If it were up to me, all basic, essential healthcare in the US would be either publicly run, or at least heavily regulated in terms of pricing.  I think there is a place for the private sector in terms of developing new tests, implants, and other products where innovation and dynamism are key (though I would not approve of such business-friendly patent laws for things like a genetic test).  But in terms of healthcare provision, the private sector seems only able scam and rent seek. 

All this worries me greatly on the eve of my family's return to the US to live.  I am worried about affording healthcare, and especially about my wife's giving birth in the US, where we're sure to pay more and have more drugs and epidurals and cesareans forced on us than we would in our small town in Colombia.  We really want to return to live in the States for a while, but the dire healthcare situation is one of a number of factors that make it daunting to establish a dignified life there.

1 comment:

  1. Hey Greg, I love reading your blog, and I'm sorry that I haven't commented more. I just wanted to congratulate you and Caro on your new baby on the way. I can't speak to cost, but I did want to let you know that I had a great experience with the midwife group at Northwestern Memorial Hospital. I was able to have unmediated births with both Dexter and Lionel, and even had a waterbirth with Lionel. Also, I know that several hospitals in the Chicago area have recently earned the "baby friendly" distinction. Though sadly NWM isn't one of them.