Healthcare in the U.S. is largely unaffordable. (Courtesy of Twitter)

There comes a time when human need and the desire to make money become irreconcilable with each other, and this has become the case with the rising debt and affordability crisis of American medicine. Indeed, it has reached the point that nothing short of a complete overhaul of how healthcare is paid for will remedy this problem. 

It is dreadfully clear to anyone that healthcare in the United States is far beyond the financial means of many Americans. This is a unique problem: healthcare in the U.S. is more expensive compared to similarly developed countries. Additionally, the U.S. is the only country that has left this universal necessity for life to the chance of the market, and in order to clean up the utter mess that the market has led healthcare to become, it is necessary to decommodify healthcare itself. 

Like many other things within this economy, the cost of medical care has consistently increased. There are a number of reasons for this: the advancement of technology demanding a greater amount of resources, the centralization and expansion of hospitals, maintenance and labor costs — and this is not the place that these will be judged — but the fact remains that the cost of healthcare has increased and continues to do so. As healthcare is a necessary, universal good — meaning everyone requires it — methods to defray the cost of healthcare have materialized: vouchers, government programs, insurance and charity. However, despite these efforts, not only has the cost of healthcare been increasing, the amount of debt Americans have taken on has also increased — that is to say, the means to make healthcare actually affordable have failed in their purpose. We see, furthermore, a very concerning trend: while people who are becoming sicker are also younger and requiring healthcare at higher rates, the cost of healthcare is rising, as is the debt of those who require it, while in emergency rooms and psychiatric facilities, there seems to be a perpetual shortage of beds. On the side of the firms providing healthcare, there are a number of other concerning trends: medical resources are being stretched incredibly thin as available trained personnel dwindle or quit due to burnout or insufficient pay, and rural hospitals continue to close, reducing the number of hospitals in areas that desperately need them.

Of course, to an economist, there is another story to be told here: that of supply, demand, scarcity and price. It is no coincidence that higher demands and dwindling supply — the most pressing issues of medicine presently — contribute to higher prices. This is a phenomenon generally agreed upon by economists and known as price-gouging. Further, it ought to be no surprise at all that firms responsible for healthcare have consistently posted higher year-over-year profits and revenues — in the case of UnitedHealth Group, the largest of these firms, that number has quintupled since 2007.

This trend has continued despite every attempt otherwise: price controls, moral arguments, charities and even vast sums of government money have failed to abate the trend — as evidenced by the existence of this problem — and even the vast coffers of the insurance industry seem to have hardly any effect on the cost of healthcare. It may be tempting, and many of those in my opposing camp do so proudly, to retreat into the belief all that is needed to abate this crisis is to reduce restrictions on the market and increase the level of competition. But this is contradictory: the market has been free and has had the desired degree of competition, and it is precisely that modus operandi which has created this problem. It would be foolish to try to fix a problem by intensifying what created it.

This, therefore, brings us back to the point from the beginning: that the decommodification of healthcare is the sole solution; that is to say, the removal of it from the exchange of commodities is the only way to fully remove the curse of the commodity fetish. This does not necessarily mean free healthcare (although this is a possibility) but instead makes possible the control of the cost of healthcare and removes it from the fluctuations of the market. Just this alone would have enormous effects on American pocketbooks. Let us examine what decommodification would look like — we will assume that the personnel that make it run are benevolent and non-corrupt, and we will assume that the level and form of care remain the same.

We may imagine that the basic decommodification of healthcare in this manner — that is, the transformation of healthcare into a public service like the post office — would require some level of government control (federal and state) over the industry. This opens the door to several possibilities: firstly, the usage of tax funds to ensure hospitals are staffed and stocked with the best resources, and secondly, the usage of taxpayer funds to cover the maintenance of those pre-existing resources. This means that the money one would pay for healthcare would simply be for the procedure itself and for expendable medical supplies used in that procedure. 

This would remove the financial pressures of wages, equipment and plant upkeep from the individual facility and place it instead in the hands of the local, state or federal government — bodies that have far more funds at their disposal and have public consent to collect necessary funds — meaning the healthcare facility will be able to focus on its intent: providing quality healthcare. There will, of course, be increased taxation at some level — as the funds must come from somewhere — but this is no different from the postal service or public transit. It will also completely eliminate the challenge of finding a hospital within one’s insurance network, as healthcare facilities, by being a public service, would be unable to deny service to anyone.

However, a valid point to be made about the potential inefficiencies of this system, portrayed by the sputtering machine of the British NHS. Without sufficient funds, authority, direction or cohesion, this may truly spell disaster for healthcare, and this is universally true no matter the way healthcare systems are set up, as we see with both the American healthcare system and the British NHS. The function of public services depends on the quality of governance itself rather than its precise form, and problems arising from within can often be mitigated by good governance rather than budget cuts. Naturally, it is easier to solve a problem if the institution responsible for the remedy has complete authority to do so, and it is here that there is a compelling defense for the decommodification of healthcare.

Kathryn-Alexandria Rossi, FCRH ’27, is a philosophy and economics major from Arlington, Va.