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The Bio-Medical Regime of US ‘Healthcare’

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Since at least the 1980s, America has shifted away from models of consumer choice towards a new managerial regime that operates based around siphoning money from the fundamental biological needs of the population. Advertisers had already begun experimenting with psychological methods of advertising which attempted to turn wants into needs, but as capital has increasingly accumulated into the hands of a few small companies, the need to push consumers into debt to simply exist as profitable entities has lead to the increased intensity of focus on specific sectors of the economy, predominantly healthcare. Serially, healthcare costs have ranked as the leading cause of bankruptcy in America, and one of the top 3 causes of debt. Healthcare costs have increased 10 fold since the 1960s, reaching an annual $10,348 per person in 2016. An MRI in America now costs over $1,000 dollars, and unnecessary medical tests and treatments executed to avoid potential legal fees total at around $200 billion annually. The cost and exact model have fluctuated quite a bit since mid-century, but have nonetheless remained on a steady upward course throughout various healthcare reforms and permutations.
           

While conservatives have made a lot to do regarding “Obama-Care”, such adjustments to the healthcare structure have not dramatically changed the situation in America, and have not brought us any closer to single-payer system, as some have claimed. On the other hand, hundreds of articles have been published attempting to show how the program has increased access to healthcare, but this “access” actually refers to Americans ability to buy from private healthcare providers. The question of access could also be described as compulsion, as those who chose not to purchase healthcare are then docked on their income tax returns at a rate of 2.5% of their annual income, which of course disproportionately affects those unable to purchase healthcare in the first place, for whom this percentage of income is particularly dear. Of course it can be conceded that the cost of medical care for those who would chose to remain uninsured is then inevitably pushed off onto the rest of society, and that this ends up being even more expensive in the long run... Yet, even lowering the cost of consumer premiums is only possible on the conditions of increased profit from other sectors. This is why large corporations like Wal-Mart have actually pushed for universal healthcare coverage: in order to offset their own expenses onto tax payers.


As a point of fact, private healthcare has become such a monstrous over-bloated beast that every year billions of dollars spill over into lobbying efforts to assure that the interests of these massive corporations are promoted, and that politicians continue to back policies which support their interests… needless to say this version of “democracy” does not entail that consumers are entitled to equal footing in terms of purchasing influence- regardless of what policy is enacted, it will be one to the taste of the corporate elite, at the expense of the sick. This occasionally takes on an extremely literal form as companies take out life-insurance policies on their employees, literally profiting from their deaths.

Healthcare companies not only influence policy, but also what kind of treatment patients receive. In 2016, it was revealed that there is a massive structure for individual doctors to receive bribes from large healthcare and pharmaceutical firms in order to promote certain brands of medication, regardless of what is best for the patient’s health and wallet. The actual decisions are made behind the scenes, and are chosen by the highest bidder.
           

Where-as some have argued Obama-care was at least a step toward a single payer system, in reality it was a system rigged from the beginning to force the poorest members of society to purchase healthcare for the benefit of private companies. Subsidies and increased coverage aside, it was nonetheless another small readjustment of a structure which always operated around the economic possibilities entailed in profiting from a product that consumers have no choice but to purchase; an industry which would could remain virtually untouched by economic recessions like the 2008 financial crisis. Regardless of rhetoric about completely scraping the policy, the Trump whitehouse has mostly made minor adjustments to appease constituants, primarily removing federal funding and subsidies while leaving the actual structure of the program in place. While pundits trade blows on the nuances of these specific policies, broader structural issues remain in the shadows of American society, and the power remains in the same hands.

While it is important to discuss the stakes of the question at hand in terms of statistics and particular policy choices, what is really in question is a specific type of ideology attached to the American economic structure, and what it means that what we could term “the biomedical industrial complex” is so completely detached from value of human life. As the sheer biological fact of life has been increasingly instrumentalized for profit, it becomes crucial to explore the ideology of contemporary American healthcare on a deeper level. While the healthcare system has many critics, it is important to avoid simply repeating arguments on the same instrumental and economic terms, and look deeply into the structure, history and even philosophy of contemporary American healthcare. Neoliberalism exists in most first world industrialized nations, but nonetheless the healthcare system in America remains unique. There is a singularly litigious character to the American system which presumes that legal structures operate on a democratic and fair basis, and that they are therefore an adequate mechanism for coping with the predatory practices of corporate entities-- yet in practice we have seen how the systems designed to mitigate between members society have come to serve as just another tool for profit. There is a connection between social emphasis on the individual legal subject as the basis of American politics and policy, and the extreme imbalance of power that has become increasingly evident. While I don’t wish in any respect to mitigate the responsibility of individuals within corporate structures of the resulting horror of their actions, these actions are an inevitable consequence of a system that can only think in terms of maximizing profits. If we are concerned with attempting to change this structure, we have to start thinking in terms of power rather than law.

Author: John Stachelski