HEALTH CARE/Joan Retsinas

Big Health and Your Health

A comforting thought is that corporate prosperity will translate into individual prosperity &endash;- that the Gross Domestic Product will measure a nation's overall wellbeing, and the success of CEOs will translate into societal prosperity. Or &endash;- as a CEO once boasted &endash;- what's good for General Motors will be good for the nation. That is the premise behind President Bush's tax cut: By enriching the rich, the non-rich do OK too.

Certainly we want the fortunes of Big Business and the rest of us to jibe &endash; like the Fourth of July and parades. We want corporate prosperity to trickle down, down, down.

So too with Big Health, we wants its corporate fortunes to jibe with our own health. As Aetna, Pfizer, Humana, HealthSouth, etc. prosper, we hope we all grow healthier. Indeed, when President Reagan invited for-profit entities to storm the health care arena, he assumed that competition for profits would yield a healthier citizenry. What's good for Big Health would be good for all of us.

The reality is not so sanguine. Sometimes Big Health works at cross-purposes with us, its patients.

Consider SARS. As the death toll mounts, the rush is on for a test, a cure, a vaccination. The stream of World Health Organization pronouncements recount that rush, but the business sections of the media recount another rush -&endash; not for a cure, but for a patent. Scientists from Canada, Hong Kong and the Centers for Disease Control and Prevention are racing to patent the genes of the coronavirus. The victor stands to profit from the subsequent treatments and vaccines, so this battle is serious. Ideally, all scientists everywhere would band together, working cooperatively to battle SARS. But first they have to decide who will profit most.

Even when somebody wrests the patent, the cost-benefit analysis may not necessarily make it profitable to search for a cure. Companies will weigh the number of victims, the cost of treatment, and the efficacy, versus the financial return. We have diseases where treatment is not profitable, so the federal government subsidizes companies to make those less-profitable drugs. Recently the Journal of the American Medical Association (JAMA) told the tale of a new drug for high blood pressure &endash; its founders stopped the clinical trials, not because the science was wrong, but because the finances were wrong.

Drug companies, moreover, do not want to put the most drugs into the hands of the people who most need them. The companies want to make the most money. As corporations, they answer to shareholders. Lower revenues might benefit patients &endash;- but not shareholders. So when states try to lower the costs of drugs for Medicaid and Medicare enrollees (via purchasing pools, for instance), the drug lobbyists yell "foul." And when consumers purchase drugs from Canadian pharmacies to save money, lobbyists again mount their legal arsenal. (AstraZena and Merck even threatened to limit sales to Canadian pharmacies that sell to Americans.)

The mega-hospital organizations are another example. Consider the latest financial report from HCA. Its profits rose 22% from last year -&endash; good news, but not good enough for investors, who expected higher earnings. Analysts ascribed the shortfall to fewer patients with flu (normally a "moneymaker" during the winter), fewer surgical procedures, fewer treatments. In short, as enrollees got healthier, corporate earnings declined. Presumably, in a universe of healthy people, HCA would go bankrupt.

Finally, look at HealthSouth America. Its CEO is headed, maybe, for jail, after the sort of embezzlement that puts the company into the Enron league. The scandal dominates the business section of the newspaper. But what about the health of enrollees? HealthSouth executives are charged with defrauding shareholders. The billion dollar fraud has not sparked an investigation into health care practices: Were referrals restricted to save money? How limited was the limited formulary? How long did patients wait for appointments? Since the primary mission of HealthSouth was to be a profit-making entity, we judge it by those criteria.

Big Health is enmeshed in corporate America: Anyone with a 401K, a pension or a mutual fund is probably an investor in one of its companies. For our financial wellbeing we wish them well. Yet as people struggling to stay healthy, we must recognize that the partnership of Big Health and us, its patients, does not always work to our benefit. General Motors' prosperity may be good for the nation &endash; the point is debatable, but plausible. The linkage between a for-profit corporate healthcare sector and our health is not so plausible.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I.

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