There are deep structural conflicts between the mission of healthcare as cooperative care to the sick and injured and that of healthcare as a business whose mission is maximizing profits. These conflicts come to the fore in the medical pharmaceutical industry. I first set these out in a context that addresses the mission of healthcare, then examine the relative roles of competitive and cooperative systems of distributive justice, and then argue for the creation of nonprofit pharmaceutical companies and the transformation of many for-profit companies into companies subject to public oversight and profit curbs. The recommendations are aspirational for the United States (because it does not yet offer universal health coverage) but it is meant to be action guiding for those industrialized countries wealthy enough to provide universal health coverage.