Profit as a Disease, and Now an Epidemic

In Why American Health Care is So Expensive, I wrote about the many things preventing us from fixing healthcare, including the profit incentive, which is misaligned with public health. Now Goldman Sachs admits that developing medical “cures could be bad for business.” While some of the newest biotech research “carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow.” These comments were part of a note designed to steer clients away from investing in cures.

As disgusting as this sounds, it’s consistent with what I’ve been saying for years, and what Stephen Brill wrote about in his 2013 TIME magazine special report, “Bitter Pill: Why Medical Bills Are Killing Us.”

The immensely profitable medical industrial complex views patients as paying customers and works to keep them coming back, paying. Prevention, or developing a one-time cure, is far less profitable than long-term treatment. That’s largely why medical schools teach new doctors so much more about diagnosis and treatment than prevention, which doesn’t fit into the profitable business models.

It wasn’t always like this. Healthcare once had altruistic patient-centered roots. But when President Nixon signed The Health Maintenance Organization Act of 1973, medical insurance companies, hospitals, clinics, and doctors were allowed to act as profit-centered commercial enterprises. They were paid to deliver treatment, not cures, and healthcare has been on a downhill spiral ever since, with no money to be made from curing disease.

Profit as a Disease

Profit has infested the healthcare industry like a cancer, and today it has grown into a full-blown epidemic that threatens our very lives and livelihood.

The profit motive not only discouraged the development of cures, but it also encourages dependence, addiction, and medical errors. Part of Obamacare was designed to prevent hospitals from charging more to fix the errors they cause, and to punish them instead for any readmission.

In Medical Errors versus Malpractice Lawsuits, I argue that Tort Reform makes the real problem – medical errors, not frivolous lawsuits – worse by preventing legitimate suits that would otherwise act as a natural deterrent. Not only do medical errors increase the cost of care, and thus the cost of insurance, but they also improve the profits from selling malpractice insurance. The more medical errors there are, the more insurance policies are sold, at higher prices.

It seems that the healthcare industry has learned that the more people suffer, the more they will pay, and the more likely they will become addicted to the treatment. Those treatments often cause other ailments that need to be treated as well, generating new profits.

For the new doctor, it starts in medical school, where they learn relatively little about prevention and how to talk with patients about the pillars of health: nutrition, exercise, sleep wellness, and stress management. Could it be that doctors profit more from treating obesity-related illness than from promoting fitness? Yes, because the incentives are misaligned with the wellness goal.

Profit becomes an Epidemic

The Profit disease is spreading to other industries, such as national defense, food production, and gun manufacturing, where market demand and profits soar after each mass shooting or 2^ndAmendment threat.

Defense Example: When President Trump bombed Syria, the stock value of defense contractors spiked, and that itself is pulling us toward war. It seems that war, death and destruction are incredibly profitable. Instead of the War Department, we call it the Department of Defense, but when was the last time our soldiers actually defended the homeland? The Civil War? The War of 1812? It’s hard to say, really. But with American troops deployed to 70% of the world’s countries, and the U.S. bombing seven nations that we know of, there sure seems to be a very large profit motive at play.

Beside the financial benefits of suffering, there are also political benefits to allowing certain people to die, or even causing death. As I describe in Politics and the Modern Killing Fields, Harvard Medical School researchers have found a 25% higher risk of mortality for the uninsured compared with the insured, after adjusting for various factors. If we apply that risk to CBO scoring of Republican Obamacare replacement bills, the 32M people expected to lose health insurance would result in 8M deaths. That’s over 100 times more than those killed in Vietnam, and 2,000 times more than killed by terrorists.

But don’t worry; they’re mostly the low-income blacks and Hispanics who likely vote for Democrats (when they can vote at all).

One can argue that the Republican motive for repealing Obamacare was political, and not just because of racist hatred of our first black President, because the CBO says it will increase overall healthcare costs and add to the deficit. But repeal efforts also seem to be motivated by fear of losing political control amid changing demographics. You see, dead people don’t vote against you.

Convicted felons can’t vote either. Where President Johnson’s War on Poverty policies sought to foster equality and economic opportunity, things changed under the Nixon administration as policing and punishment largely replaced welfare programs. That turned America from a “land of the free” into the world’s largest for-profit prison system — a system disproportionately filled with blacks. There was likely both a profit and political motive behind that.

Is there a Cure?

How can we fix our ailing healthcare system and find a cure for the Profit Disease? Maybe we should step back and ask different questions. Start with, “Is basic healthcare a right, privilege, or a personal responsibility?”

We might also look at healthcare differently if we spent less time debating wars and walls, and spent more time looking in a giant mirror to show what we’ve become.

As with any disease or epidemic outbreak, identifying the cause and other contributors is critical to finding a cure. Human greed is itself a cause, along with the profit motive. This is causing the wealth gap to widen and allows the wealthy to gain even more political power.

The Supreme Court’s Citizen’s United decision is a contributor to the widening influence of wealth. The corporate culture is another contributor, because CEOs now have a legal responsibility to serve the investment interests of shareholders over all else. And they’re often measured on quarterly stock price. Without strong regulatory oversight, corporations will continue to make relatively short-term decisions and show psychopathic behavior.

Unfortunately, there has been an unconstrained consolidation of power within many industries, including the news media (e.g. Sinclair Broadcasting), telecommunications, Internet search, online shopping, social media, air travel, health insurance, and more. Multinational corporations keep gaining market control and political power, thanks largely to a weak Federal Trade Commission and a deregulation trend under the Trump administration.

As I’ve said before on this website, fixing healthcare (and other industries infected by the Profit Disease) must start with fixing campaign finance laws, our voting process, and our political system. That, I believe, starts at the local level with diversity of candidates by age, gender, race, nationality, and political affiliation.

I love this video of Jennifer Lawrence talking about government corruption with students as they get ready to graduate and vote for the first time. As for my own efforts, I’m working with local progressive candidates to help them understand healthcare and related issues where I offer a unique perspective.

I encourage you to add your reaction and perspectives in comments below.