Daraprim and the Morality of Healthcare Markets

The recent story about Turing Pharmaceuticals purchasing the rights to Daraprim – a uniquely effective drug for a particular parasitic infection that is especially important for people with compromised immune systems (i.e. those with diseases like AIDS) – and raising the cost from $13.50 to $750 per pill is illustrative of, as Michael Sandel would say, the moral limits of markets (although I haven’t read his book on the topic yet). Daraprim, as the link notes, is only the most recent instance of this not-so-rare practice.

Is this sort of price gauging wrong? Or does it just feel like it is? From a purely business perspective, the CEO of Turing could be seen to have made a shrewd financial move, very possibly netting the company huge profits. And didn’t the company do this fairly and transparently in an open market?

However I think there’s genuinely something very wrong here. The critical thing is to try and pin down exactly what that is.

Is it wrong to charge money for medicine? I can see many people saying no who nevertheless find the act of Turing reprehensible. It seems the sticking point may be the artificial inflation of the cost of medicine for reasons of pure profit. But are pharmaceutical companies not allowed to make money on medicines to which they own the rights? And aren’t all prices set to be profitable for the seller by design? It seems to me there are two reasons for most of the public outrage: 1.) the price increase took medicine that was reasonably affordable and raised its cost to such an extreme that very few could afford it; 2.) this act of price raising, at least at this scale, is exploitative precisely of people who are suffering (in this case those who are sick).

I don’t disagree with these two reasons, but I think they’re insufficient in explaining what exactly is wrong here. That insufficiency is made clear when you press the thinking in these two points by asking what exactly constitutes a “reasonable price.” After all, there were still people who needed the medication and couldn’t afford it when it was priced at $13.50 per pill.

This extreme example serves to highlight an underlying, more fundamental moral concern for me. My concern is that subjecting pharmaceuticals, and really all aspects of healthcare, to bald market forces – which could include going market rates, competition, greedy corporate CEOs, and actuarial judgments of risk – serves to commodify human health. Such commodification is problematic because it means putting a price on medically necessary goods and services, which inevitably results in access only to those with certain means. However even more morally problematic is that it casts human health as something that can itself be bought and sold, something monetizable. It dehumanizes the individual by locating the value of her health, and by extension her life, in external market forces rather than intrinsically according to her personhood.

As I see it the moral problem here can be located in the instance of medicine having any cost at all, but such an extreme example makes the point more obviously. From where I stand as soon as the health of a person becomes profitable and subject to unbridled market forces, a moral problem emerges. The health of a person isn’t a commodity to be marketed, bought, and sold.

Private health insurance doesn’t go very far to meet this concern because it too is subject to the same parameters. Private health insurance can help cushion the costs of healthcare, but who is eligible and how much it cushions the costs and how much the premiums might be are determined by the same market forces.

Practically my concerns could be rather substantially addressed by a single payer healthcare system. In such a system everyone collectively contributes to the health coverage for all, and no one remains uncovered. While money is still spent on healthcare in such a system – hospitals are built and staffed, doctors are paid, pharmaceuticals are developed – it is because of the shared incurred cost of covering everyone. This cost does not include much of a profit margin for the system and the costs are therefore determined largely by the cost of operations.

Most importantly, however, in such a system everyone is covered no matter how much money they have or can contribute. By design such a system is built upon the belief that every person deserves adequate healthcare and that each person’s health is an individual and social good. It’s not perfect, yet while such a system recognizes the practical costs of providing healthcare it neither leaves people without coverage nor does it relegate the health of an individual to a measure of individual cost. The universal nature of such a plan would go far in curbing market forces and absorbing the necessary costs.

It costs to provide healthcare, but human health is not a mere matter of cost.

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