This bloodless technocratic language should sound familiar: It’s the same attitude exhibited by the V.C. at that tech conference a few years back, and it is totally removed from people’s fundamental material needs. There’s talk of ease of access and furnishing better care but little discussion of what really matters: universal care that’s free at point of service. Nor do Silicon Valley’s would-be health care entrepreneurs evince much concern for concepts like health care justice, reproductive rights, or repairing systemic inequities. New algorithms may hold out promise for processing masses of medical images, but even these supposed breakthroughs come with deficiencies, often owing to biased training data. One New England Journal of Medicine study found that algorithms used in a variety of medical contexts can reinforce racial biases, compromising care. In this arena, “disrupting” health care doesn’t mean repairing a broken system; it means leveraging that system’s vulnerabilities to innovate new delivery systems and new forms of profit.
That V.C.’s dream of Americans spending more of their income on health care may have been ghastly in its insensitivity to people’s real concerns, but it remains a sad market reality. U.S. health care spending grows consistently, reaching $11,582 per person in 2019. Insurance premiums—and insurance company profits—have risen far faster than workers’ wages. One study found that Americans now spend double on health care what they did in the mid-1980s. Tales of Americans refusing health care for fear of bills—passing on an ambulance ride or delaying treatment for an acute condition—are legion. Medical bills remain one of the leading contributors of consumer bankruptcy—a novelty for large swathes of the world where no one must pay for medical care, much less risk bankruptcy.
The solution, as it’s long been, is clear: a universal health care system that provides free care. The principle is as simple as the fire department or the local library—shared services that everyone pays into and are free when they need them—but it’s one that would likely be lost on most politicians today. (If public libraries were proposed now for the first time, how many Democrats would join Republicans in voting against them?)