Health Science

The exact reason for the assassination of UnitedHealthcare CEO Brian Thompson may never be known, but it has certainly brought into focus the widespread frustration with medical insurance. The reluctance of insurers to pay for medical care care often enough means that people fail to get proper medical care, leading to pain, disability, and early death. Medical expenses drive many people to bankruptcy, despite their having medical insurance that on the surface should have prevented financial disaster. The medical insurance industry is generating tidy profits. Thompson's compensation was $10 million per year, and no doubt other top executives are similarly well off. There is a clear imbalance between the benefits to executives and stockholders, versus their customers.

Of course, many corporations beyond the medical insurance industry are also biased toward shareholder profits and executive compensation, at the cost of the quality of the products delivered to their customers. What makes medical insurance special is the degree of need. Medical care is often a matter of life and death. But medical insurance is just one component of medical care. U.S. health care expenditures total $4.5 trillion. Private insurers paid about 30% of this, or about $1.4 trillion. About $0.25 trillion went to the insurance companies themselves, for expenses and profits. So medical insurance is about a 6% overhead on medical spending. The small size of this number doesn't reflect all the costs of the insurance industry: for example, they have a lot of control over who gets what treatment, and may make inefficient decisions. And of course the real bottom line is not financial, but people's health.

I have seen charts that compare U.S. healthcare costs and outcomes with those of other countries. It looks quite clear that the U.S. spends an enormous amount on health care, but does not get commensurate health care results. People often post medical bills on social media, with astounding charges, often for relatively routine procedures. Pharmaceutical prices are often prohibitively expensive. To some extent, the medical insurance companies are caught in the middle. People cannot afford to pay huge insurance premiums, but they often need very expensive medical care. The insurers have somehow to allocate available funds to the most necessary care. No doubt they do an imperfect job of it, but the task is really impossible.

Health care corporations are like any other corporation: they are controlled by shareholders whose goal is profit, return on their investment. What incentives can be put in place to motivate corporations to provide high quality products at fair, affordable prices... this is a general problem. Part of the solution is the competitive nature of markets. Part of the solution is regulation by governments or other supervisory bodies. Part of the solution is cultural, a matter of changing understandings and expectations among all the various players.

Health care is a vast network of businesses and practices. Ultimately, it incorporates everything we do. For example, workplace conditions create stresses that often result in strains and injuries requiring medical attention. If workplaces were less physically stressful, there would be less need for medical care. Health care starts at home. If people help each other catch problems when they are small, there would be less need for medical care. How much of our increased medical expense is due simply to the increase in people living in greater isolation, away from extended families, away from people who catch problems before they need professional attention?

My particular interest here is in the scientific facet of healthcare. Medicine is the supreme example of a science where pure science and applied science are inseparable. Modern science is founded on physics, the supreme example of a science where pure science and applied science are separable. This separation of science from its use bears much responsibility for our global environmental crisis. Modern science is essentially driving itself out of business. The environmental crisis and the healthcare crisis are both pointing to the need for a new kind of science, a new vision of science, where pure science and applied science are understood to be inseparable. Medicine is thus the proper foundation for this new science. The healthcare crisis represents the birth pangs of a new science.