(Photo: AP/Brennan Linsley)
Since the sweeping health-care law best known as Obamacare took effect in 2010, Republicans have voted 63 times to repeal or gut it, and Democrats have argued over whether to expand it or scrap it in favor of a public single-payer plan.
But not much attention has been given to going beyond the Affordable Care Act to take on the root cause of our nation's most serious health problems: a corporate system that profits by sickening people. Yes, the ACA dramatically improved American health-care access-about 20 million Americans have gained insurance coverage, and nearly 71 million now enjoy expanded access to free preventive services through their private plans.
But the bitter fact remains: The nation still pays more for health care than any other high-income country, but with worse outcomes. A recent study by the Commonwealth Fund found that the United States ranks last among 11 wealthy nations in indicators of healthy lives and health equality, but first in per capita spending on health care.
Ample evidence suggests that reforms that better protect the public against the harmful practices of the drug, food, firearm, and car industries could save millions of lives. Can progressives who want to target corporations' role in undermining health, democracy, and the environment leverage the 2016 election to spark a new round of health reform?
The key to truly improving Americans' health and quality of life is to go beyond simply getting individuals to the doctor or to the emergency room sooner, and to actually change the business practices that put people at risk of early death. Tackling four health policies-affordable medicines, a healthier food system, gun safety, and better transportation-could prevent millions of premature deaths and preventable illnesses and injuries and garner support from the vast majority of Americans. In an election dominated by talk of the one percent, opportunities abound to challenge the policies of a corporate elite that values profit over health. Let's start with drug industry reform.
Affordable Drugs: Three-quarters of Democrats, Republicans, and Independents tell pollsters that the top health-care priority for the next president and Congress should be making high-cost drugs for chronic conditions affordable. The pop-culture villain for skyrocketing drug prices is Martin Shkreli, the drug entrepreneur who in 2015 increased the price of an AIDS drug from $13.50 to $750 a pill. Shkreli, however, is just one flamboyant symptom of an industry that consistently puts profits ahead of public health. Between 2010 and 2015, for example, the price that three major manufacturers charged for insulin, the drug used to treat diabetes, more than doubled. During this time, Eli Lilly, Sanofi, and Novo Nordisk used various ploys to extend the patents on the most expensive forms of insulin, blocking competition from cheaper generic options and keeping prices high. In 2014, these companies made more than $12 billion in profits, with insulin accounting for a large portion.
The Centers for Disease Control and Prevention has predicted that the number of Americans with diabetes will double or triple by 2050, magnifying the burden of this disease on Americans of all political persuasions. Because high prices for insulin force many diabetics to skip doses, more patients with the disease will be at risk of amputations, blindness, and other complications.
In Europe, insulin costs about one-sixth of what it does in the U.S., mainly because governments control prices.
Most of the largest pharmaceutical companies have abandoned the less-profitable antibiotic market, despite the threat of epidemics like the Zika virus and drug-resistant tuberculosis. Instead, they invest billions in tinkering with existing drugs for diseases like high blood pressure and diabetes that differ little from available alternatives (except in price), but that extend patent protection for name brands that yield higher profits. Voters would respond well to candidates who championed the government's right to take actions that make essential medicines affordable to those who need them.
Improve Diet: Food policy is another arena ripe for action. Diseases related to poor diet are rapidly overtaking tobacco as the leading cause of premature death and preventable illness in the U.S. They are also a primary cause of racial and socioeconomic health disparities. No public policy could better erase these inequities, improve health, and shrink the costs of care than fixing a food system that makes foods high in fat, sugar, and salt cheaper and easier to find than healthier fare.
Through her "Let's Move!"campaign, First Lady Michelle Obama has expanded the national discussion on food to focus on government and corporate as well as individual responsibility for improving the nation's diet. But despite modest concessions, the food industry still resists any regulations that put better nutrition ahead of corporate profits.
The recent spat between Hillary Clinton and Bernie Sanders over Philadelphia's proposed soda tax illustrates the political opportunity to reframe the debate over nutrition issues. Clinton supported the tax as a good way to fund preschool education, and Sanders opposed it as regressive because poor people would pay a higher share of their incomes on soda.
But both missed the chance to focus attention on the Coca-Cola and Pepsi Companies' immoral business model. When white men started giving up cigarettes, the tobacco industry looked to create new markets among women, blacks, and Latinos. Similarly, as soda drinking among adults declines, soft drink companies are marketing sugary beverages heavily to children, young adults, blacks, Hispanics, and people in developing countries. Obesity and diet-related diseases have many causes, but soft drinks are the one product most consistently associated with their rising rates.
Candidates who favor limiting the marketing of products that cause illness can win the support of parents and families concerned about their health.
When President Barack Obama suggested voluntary guidelines for food companies marketing to children in 2011, the food industry spent more than $175 million on a lobbying campaign that forced the Federal Trade Commission to ultimately drop the plan. Parents who want healthy food for their children, millennials who are rejecting junk food diets, and people who need healthier diets to control their diabetes are all potential constituents for candidates willing to stand up to the food industry.
Gun Safety: Preventing premature deaths and injuries from firearms provides another opportunity to improve the health of Americans. The gun industry and the leadership of the National Rifle Association have successfully framed firearms as an essential element of American culture, casting unrestricted gun ownership as a moral and constitutional right.
In a provocative new book titled The Gunning of America, historian Pamela Haag argues that in earlier times guns were just another commercial product. It was aggressive marketing and price discounts that helped Colt, Winchester, and Smith & Wesson build an American market for guns. Mass production led to overproduction, and to an industry imperative to develop new markets or lose money. Creating a culture that fetishized firearms proved a powerful marketing tool.
In this election, the gun safety movement should seize the opportunity to question the human costs of this manufactured culture. A recent Gallup poll found that 55 percent of Americans support stricter gun-control laws. Only a movement that aspires to challenge the clout of the NRA can convince candidates intimidated by the gun industry that a product that has killed one million Americans and injured another two million since 1960 warrants the same regulatory attention as other lethal but legal products. A movement that persuades the American people that a declining industry survives by sanctifying an imaginary past in order to sell more powerful and bigger guns could advance majority-supported proposals to reduce gun violence.
Fix Defective, Polluting Cars: Americans have long struggled to find a way to balance their love affair with automobiles with their desire for livable cities, safe travel, and clean air. The auto industry has always resisted regulation and fought to undermine rival forms of transportation. After several recent auto-industry scandals, 2016 is the right time to revisit the costs of national transportation policies that are designed to benefit car-makers. Volkswagen's rigged emissions tests; Ford, Chrysler, and Toyota's massive recalls; General Motors' decade-long cover-up of defects in its ignition switches; and Takata's stonewall of investigations into its faulty airbags have placed the auto industry under more scrutiny than at any time since Ralph Nader published his watershed book, Unsafe at Any Speed, in 1965.
Having steadily declined for decades, both annual deaths and injuries from car crashes went up in 2015, and rates in the U.S. are still much higher than in other Western nations.
Even more important for saving lives is the growing evidence that automobile pollution is a major cause of heart and lung diseases, both leading killers in the U.S.
A new report by the American Lung Association found that half of Americans live in areas with often dangerous air-pollution levels.
What could a new president and a new Congress do to reduce the health toll from automobiles? Most independent safety experts agree that over the last two decades the National Highway Traffic Safety Administration has lost the staffing, expertise, and political will to keep up with the global auto industry. Blocking the revolving door between the agency and the auto industry would help restore its scientific credibility. Beefing up enforcement so that auto executives who make decisions that cost lives risk going to jail could also help prevent auto injuries and deaths.
The government can also use industry incentives and penalties to encourage the production of safer, less-polluting vehicles. Prior to the 2008 economic crisis, the auto industry heavily promoted SUVs, claiming it was merely responding to consumer demand. But SUVs are 10 to 12 times more profitable than sedans so, not unlike firearms, they were marketed aggressively and discounted to increase sales and profits. When energy prices went up, SUV demand dropped. Now, GM and Ford are again promoting luxury SUVs-dangerous and polluting behemoths that contribute a disproportionate carbon footprint. By insisting on stronger pollution standards and adding surcharges or luxury taxes for SUVs, Congress could save lives, reduce pollution, and slow global warming.
This year's crop of presidential candidates could easily make corporate accountability for health a campaign issue. Sanders won support in the primaries in part by attacking the power of big corporations to make decisions that shape people's lives. Clinton has talked tough about limiting predatory pricing of essential medicines. In a very different way, Donald Trump has tapped into the deep distrust that many Republicans feel toward corporate elites. Public opinion polls confirm that big majorities of Americans favor stronger public health protection from the industries that seek to profit at the expense of the American people's health, democracy, and environment.
So far, no political movement has woven together these diverse strands of activism. Likewise, no single organization has promoted a policy agenda to reverse the corporate practices that endanger the health of millions of Americans and widen the health inequities that contribute to wealth gaps. But the opportunity exists to translate voters' aspirations and fears around both economic and public health concerns into political action.
No parent or family wants a child or grandparent to be exposed to the marketing and promotion of products that have been proven to sicken, injure, or kill. No one wants to live in a community without access to essential medicines, healthy food, and clean air or water. Not many people would knowingly choose a system that provides public subsidies to dangerous or life-threatening products, and that then allows their manufacturers to charge the public for fixing the health and environmental problems they cause. Increasingly, voters oppose the concentration of political power in a tiny handful of giant corporations and super-wealthy individuals.
All this sets the stage for the next generation of health reforms. Candidates and public officials should be thinking now about specific policy proposals to promote essential medicines; healthy, affordable food; gun safety; and safe, non-polluting cars. They'll be promoting public health and social justice at the same time, tapping into our deepest aspirations while also recognizing the growing fears about losing our democracy to big corporations. By using the 2016 campaign to tell that story, progressives can help launch the next wave of improvements to American public health.
This story was posted in conjunction with the Scholars Strategy Network.
