Dr. Michael Fine: Capitalism Is Bad for Your Health
Photo: Sokontha Thuong, Snicca Photography. For months, the fate of the United States’s healthcare system—one-sixth of the largest economy in the world—has seemed to be up for grabs. In May of this year, the Republican-controlled House passed a “repeal-and-replace” bill that died in the eleventh hour in the Republican-controlled Senate. Mitch McConnell announced that it was “time to move on,” and President Trump, known for graciousness neither in victory nor defeat, tweeted, “Let ObamaCare implode, then deal. Watch!” As of this writing, the Graham-Cassidy Act, which would dismantle Obamacare in favor of block grants for individual states, seems to have met an abortive end. Meanwhile, Bernie Sanders has announced a single-payer plan he calls Medicare for All; though it has no hope of passing the Republican-controlled Congress, its sixteen cosponsors include 2020 presidential hopefuls Elizabeth Warren, Kamala Harris, and Kirsten Gillibrand, signaling universal healthcare’s shift toward the center, at least among Democrats.
The only thing everyone seems to agree on is that the American healthcare system is in dire need of an overhaul. The Unites States spends over $3.2 trillion on healthcare annually, or $10,000 per person—more than twice the per-capita healthcare expenditure of other industrialized nations. Yet we lag behind those nations in important health indicators like life expectancy and infant mortality rates. That’s to say: we pay an exorbitant amount for healthcare that doesn’t even keep us healthy.
Dr. Michael Fine, a family physician, former director of the Rhode Island Department of Health, and current chief medical strategist for Central Falls, Rhode Island, believes that we’re missing a crucial point in our debates about healthcare. As he put it to me recently, “The problem with Obamacare, and even with the attempts to destroy it, is that they are all attempts to do a little social engineering by using the health insurance process. Obamacare was health insurance reform; it was not health care reform.
“We’ve done it backwards,” Fine says. “We’ve tried to figure out how we’d pay for it, but we haven’t figured out or articulated what it is.”
Instead of figuring out how to finance our ballooning, unsupportable healthcare industry, we should be questioning why American healthcare costs so much in the first place. In order to solve our healthcare crisis, Fine argues, we need to begin by developing a comprehensive understanding of what a rational, effective, and just healthcare system ought to look like.
Dr. Fine’s vision of health and healthcare is localized, community-based, and integrative: not just avoiding or managing illness, but supporting education, affordable housing, public transportation, and sustainable resources—elements that link to health in surprising ways. The cornerstone of Fine’s own healthcare strategy is the neighborhood health station, a facility that aims to provide almost all the care that patients need, in one
