The fundamentally political questions at the core of everything healthcare:
Is all healthcare or any healthcare a human right or is healthcare a consumer product — you get what you can pay for? (This is the big one, the political healthcare question that drives all the rest.)
Is there a societal-level interest in the safety or efficacy of healthcare — at the levels of who can provide it, what they can provide, and how they are accountable for it — or is it an individual-level interest? Is buying healthcare more like driving on a highway or pulling up onto your driveway — a common interest and responsibility, or a private one?
What is the ultimate societal value of healthcare? The most healthy lives for the most people? A well functioning marketplace that drives profit and the economy? Is healthcare more like the air traffic control system, with a clear public benefit, or is it more like streaming media services, with mostly clear private benefits?
Enter Hims, a startup that’s obscuring a campaign for a particular future of healthcare. Yes, Hims (and Hims competitors) are inherently, inescapably, political.
To be clear, Hims hasn’t been directly involved in elections (it doesn’t have a corporate PAC and doesn’t appear to give to the Chamber of Commerce or other member organization that makes political contributions.) Hims founder and CEO, Andrew Dudum, didn’t go the route Expensify CEO David Barrett did — no official voting advice from him. Dudum did make sizable contributions to Democrats running for federal office this past cycle, including to Joe Biden in the fall and, interestingly given the politics of Hims as a business model, to Bernie Sanders during the Primary.
Hims (and Hers) has political advocacy built into the very DNA of its business model. Dudum leads companies that answer healthcare’s core political questions in ways that conflict with his personal political giving.
Hims (and Hers) answers the question of whether healthcare is a right or a consumer product very clearly on the side of “it’s a consumer product.” Dudum recently told Businessweek journalists Kristen Brown and Gerrit De Vynck Dudum that, “salesmanship can still change U.S. health care for the better, and he’s committed to working in the field until those changes are manifest.”
“Ten years from now,” [Dudem] says, “the health system is going to look and feel more like consumer brands than hospitals.”
In the Hims campaign for a healthcare system, paying for healthcare is also just like paying for any other consumer product — as expensive as the market will handle. Hims drugs aren’t covered by insurance, and many of them cost orders of magnitude more than getting them through traditional (insurance covered) providers. COVID tests, which are widely available for free as part of many communities’ public health response, and required to be covered by insurance if the test is “medically necessary” — generally assumed to include if you are symptomatic — are available for $150 from Hims. The test is sold specifically to people who are symptomatic, with a turnaround time of results of 3–5 days “from when the test is sent to the lab.”
Safety is ultimately an individual responsibility — consumers of Hims healthcare are on their own. Again quoting the Businessweek article, “Most of the medications Hims and similar companies sell right now are relatively low-risk. People rarely get addicted to Viagra or die from complications with Rogaine. But every prescription drug has a measure of risk, one that can spike if a patient has unreported comorbidities such as a heart condition or diabetes. And if the future of U.S. health care looks a lot more like Hims, as Dudum is fond of saying, it may be a future in which doctors no longer stand between drug sellers and patients to make sure people don’t take risks with treatments they don’t need.”
In the politics of Hims, The goal of healthcare is a marketplace that delivers opportunities for profit. Hims has said it expects a large slice of its future revenue to come from antidepressants — a category of drugs many patient advocates argue are already overprescribed, and are generally understood to be best utilized under regular treatment and observation. The goal of direct to consumer delivery of (expensive) antidepressants on demand, outside a regular treatment protocol, is very clearly not better health for most people. It’s profit.
Every element of Hims business is political, a campaign for a specific version of the future built on particular answers to the core political questions that drive how healthcare works.
Every time Hims incentivizes an MD to rent out their qualification to make it easier for a consumer to get the prescription drug they want, Hims is engaging in politics — campaigning for a version of healthcare where the political question of the role of healthcare in our society is answered in this particular way.
Every time Hims adds another standalone drug or test to its list of offerings, thanks to outdated or even rolled back regulations, they’re campaigning for a version of healthcare where prescription drugs are no different than, say, coffee — it’s on every consumer to decide whether that drug is a good idea and keep track of what’s safe and what isn’t. Any assertion against uniform regulation of prescription medication is an extraordinarily political one — Hims is campaigning for it every day it does business in this way.
Everything is politics. Startups are campaigns. Is the Hims campaign on healthcare one you’d vote for?