Opioid addiction in our healthcare system

More and more often, I pick up the morning’s Gettysburg Times and discover an article about an Adams County neighbor who has fallen victim to opioid addiction. My first instinct, I admit, is to blame the big drug companies. Purdue Pharma, in particular, deceived doctors into proscribing opioids as pain-killers by falsely claiming they were not addictive.

But it turns out there is a darker truth. All over America, people are dying at unprecedented rates from three major causes: drug overdose, liver disease resulting from alcohol addiction, and suicide. These three have come to be known as the “deaths of despair.”

Two economists, Anne Case and her Nobel prize-winning husband Angus Deaton, decided to look carefully into the possible causes of these premature deaths. Their recent book, Deaths of Despair and the Future of Capitalism (Princeton, 2020), demonstrates that these death-rate changes have not occurred in other industrialized countries. More dishearteningly, the deaths are not taking place at the same rate in all segments of the American population. The increase in “deaths of despair” is occurring among working class people, those who have not graduated from a four-year college. Weighed down by stagnant wages, rising personal debt, limited prospects for career advancement, and a sense that the economy is leaving them behind, these people are increasingly taking their own lives with drugs, alcohol, or even a revolver.

Why discuss working-class despair in a column about healthcare? Because among the forces pushing working-class people down, Case and Deaton point to an unexpected villain: the budget-breaking cost of healthcare. The misdeeds of drug companies turn out to be a symptom of a larger problem. “The healthcare system,” the two economists write, “is a uniquely American calamity that is undermining American lives.” (p. 9) “Needlessly eating away at workers’ wages,… it not only holds down wages but also destroys jobs…” (p. 191)

As economists, Case and Deaton understand how a capitalist system such as our own relies heavily on market forces. But in the case of healthcare, they argue, the market is unable to do what it ought to do: keep prices down. Faced with a sudden medical emergency, patients lack the time and information to make the informed choices that a free-market would require. As anyone who has ever puzzled over a hospital bill knows, it is often next to impossible to discover the full cost of a medical procedure (even afterwards, let alone ahead of time). In addition, healthcare lobbyists (the industry employs more than five for each member of Congress) push for laws that stifle market competition (such as the requirement that Medicare not negotiate on the price of prescription drugs).

These weaknesses in the market have encouraged healthcare providers to become especially adept at charging exorbitant prices for their services, something economists call “rent-seeking.” Like landlords in areas where housing is scarce, drug companies, hospitals, and other providers face too few obstacles in their goal of charging ever-rising prices (“rents”) for their services. Those who believe that we should allow the market to create the fairest healthcare system need to recall that before the passage of the Affordable Care Act, American healthcare operated in a “free-market” system. That system left nearly 40 million people without the insurance they needed to afford their healthcare. Recent history shows that the market alone cannot repair a broken system.

Case and Deaton conclude that a lack of inclusive, affordable healthcare is a major contributor to a climate where despair — addiction, alcohol abuse, even suicide — infects large numbers of our fellow Americans and compromises our democratic system of government.

As Americans weigh their choices in the upcoming November election, they are telling commentators that they consider healthcare to be their number one issue. My colleagues and I on the Health Care Task Force continue to urge elected officials in both parties to listen to the American people and stop kicking healthcare reform can down the road. Let’s work toward a system that is accessible, affordable, and provides the best quality healthcare in the world.

Baird Tipson has been a member of the Health Care Task Force since 2011.

HealthcareBaird Tipson