While many students may pass by Indiana University Hospital on their way to class, 87 percent of rural Indiana residents live in a primary care shortage area. Healthcare costs have also risen enough for the Indiana legislature to form a special committee to figure out how to address the problem. As such, The Collegiate Commons took the opportunity to review the healthcare policies put forward by John C. Medaille, retired businessman and theology instructor at the University of Dallas, in Towards a Truly Free Market.
Medaille’s book centers around the economic philosophy known as distributism, which emphasizes widespread ownership, and as such, opposes healthcare corporations being concentrated in the hands of a few.
Medaille wrote Towards a Truly Free Market in 2010, the same year the federal government passed the Affordable Care Act.
The law increased healthcare coverage for the uninsured. However, large corporations could handle the new regulations easier, so the policy effectively encouraged smaller corporations to consolidate through “mergers and partnerships between hospitals and insurance companies,” according to the National Institutes of Health.
“It’s time for some serious antitrust enforcement,” said Medaille in a Facebook message with The Collegiate Commons.
The book recommended patent and medical licensing reform among other things to make the healthcare system more equitable.
Patent Reform: Breaking Down Barriers
Prescriptions and medication can be costly.
According to the Health Policy Institute at Georgetown University, “the annual [average] out-of-pocket prescription drug expenditures for all adults are $177.” Those over 50, however, pay significantly more.
In a market economy, the potential for profit encourages innovation. However, according to Medaille, the patent system that prevents others from duplicating a new drug creates a virtual monopoly with little incentive to keep prices low.
“The monopoly cannot have it both ways: they cannot insist that the government enforce their monopoly rights while demanding that the government take no role in pricing,” said Medaille.
The government, along with nonprofits, already funds a great deal of the research that companies take advantage of to develop new drugs. 87 percent of the drugs produced between 2010 and 2019 involved at least partial funding from the National Institutes of Health.
“Much of the initial research occurs in public universities, which then form companies to attract new funding,” Medaille told The Collegiate Commons. “Maybe one in twenty of these companies pays off, but the profits are enough to justify the risk, and the profits are huge.”
Distributism would suggest the public should own a greater stake in what the government invests their tax dollars in.
“Although the Universities profit, the public does not; they get nothing for their investment; the expense is public but the profits are private,” Medaille told The Collegiate Commons. “This is why so many public universities are trying to become research centers and downplaying any actual teaching. Students are a real hindrance to the ‘business’ of a modern research university.”
Medaille recommended taking advantage of antitrust laws to keep drug research and manufacturing separate, to encourage drug developers to keep prices low to sell to as many manufacturers as possible.
“What research does require is a reliable funding source, which can come more efficiently from manufacturing licenses than from patents,” said Medaille. “That is, when a firm develops a new medicine, they get the right to license that product to any number of production firms.”
Healthcare Worker Reshuffle
Medaille also suggested that the current licensing system for medical professionals is too restrictive.
“The proliferation of licenses [would likely be the most beneficial for rural healthcare equity],” Medaille told The Collegiate Commons. “Midwifery is likely the most vulnerable area, especially in the countryside. But Nurse Practitioners with their own emergency or primary care clinics would be most useful for rural areas.”
In his book, Medailled pointed out that it could help to break up the commitment of medical school to allow for different levels of licenses as well.
“As things stand now, a student will spend most of his youth and all of his fortune in getting an MD, and will still be left with staggering debts,” the book said. “Yet, he will have a degree in a profession he has not actually practiced. A series of licenses will provide the student with a career path by which he may alternate education with practice. He will have an income stream with which to finance his education, but he will also have practical experience to take to each successive layer of education.”
Julian Strobel, a medical student at the IU School of Medicine, however, suggested that medical students would be unlikely to choose to break up their education given the large amount of information learned in medical school that is not used in a clinical setting.
“A lot of knowledge is lost when practicing in a clinical setting and not studying as a student,” he told The Collegiate Commons. “This would likely result in additional time spent preparing for licensing exams and regaining knowledge that is not readily seen in a clinical setting.”
Strobel suggested that, instead, medical school graduates could be given the option to work in the same capacity as a lower-level provider such as a physician assistant before going to residency.
“This might give anyone who is burnt out a pause and allow them to work a well-paying job in their field,” he said.
Community health workers and lay health educators
Many physicians, especially primary care doctors, are performing a great deal of work that they are overqualified for anyways, leading some to burnout, according to physician and columnist Matthew Loftus.
“I didn’t do seven years of medical training to click boxes and harangue people about how to quit smoking,” he said, “and yet that’s what a primary care doctor ends up spending a lot of his or her day doing.”
Physicians also end up spending half of their time at work documenting in the Electronic Health Record.
In addition to licensing reform, Matthew Loftus has suggested that expanding community health worker (CHW) programs and scope of practice could greatly alleviate a multitude of duties physicians have to perform daily. CHWs could become the bridges between communities and healthcare, offering essential basic services and education where it matters most. Lay health education programs could also allow doctors to partner with churches or other local organizations to teach trusted community members to take on some of these roles.
Patients also often struggle to make use of limited patient care time effectively, further emphasizing the need for trusted community members to educate where they can.
“I’ve realized there’s a large variation in levels of knowledge about healthy menstrual cycles and their role in fertility.” said Lauren Onak, a parishioner and natural family planning (NFP) instructor based in Massachusetts, in a Facebook message with The Collegiate Commons. “Though I cannot give my clients medical advice, I can help them come up with a list of questions for their healthcare provider that they might not have thought to ask.”
Onak is also running for vice-president with the American Solidarity Party, a third-party that advocates for a distributist economic approach.
Expanding the number of medical licenses available and making use of community health workers and lay health educators seems to fit in with a distributist approach because it has the potential to put medical decision-making back into the hands of local communities and individuals.
While distributism may seem like an obscure economic philosophy, Medaille is convinced that students and young people should care about it, especially when it comes to healthcare.
“Healthcare consumes about 20 percent of the GDP, and most of that goes to old codgers like myself,” he said. “My generation has an obligation to yours, one we have inverted.”
If you are interested in reading Towards a Truly Free Market, you can purchase the book here.
Riley Abell is a senior Chemistry major at Indiana University Purdue University of Indianapolis. Being in the state capital, he is surrounded by various health institutions and drug manufacturers, such as Indiana Health and Eli Lilly. Riley grew up in the small city of Jasper, Indiana, where there was only one hospital for miles around. Seeing this dichotomy between rural and urban healthcare, Riley has spent much of his time researching solutions to the problems of equity and accessibility to healthcare across Indiana and the nation. Jacob Stewart, a neuroscience major at IUPUI, helped performed research for this article and interviewed the quoted individuals. Featured image courtesy of Daderot – Self-photographed, Public Domain.