Folks will tell you that the American health care system is the best in the world because it is driven by profit. With profit as a motivator, the industry (not the profession) has every incentive to invest in new technologies to make us live longer, healthier, happier lives. Or so we are told. So, why does the United States languish at the bottom of the list of health indicators when compared to other first world nations? Because “for-profit” and “health-care” are mutually exclusive.
The basic tenets of medical professionalism can be summarized:
1. First Do No Harm. That does not mean the needle does not “ouch.” But it means the “ouch” is not as bad as the disease it is meant to prevent.
2. Equal justice. No matter what personal prejudices the health care provider may hold, he or she will give care to all according to their needs. No matter what prejudices the people around him may hold, the provider will continue to give care to all according to their need.
3. The needs of the patient come before those of the provider.
Why are these rules of “professionalism” necessary for nurses, doctors, therapists and other health care providers? Sick folks and those trying to stay healthy come to us with their secrets, their fears, they tell us things they would not tell another soul, they put their trust in us, they allow themselves to become vulnerable. This is a relationship which would be easy to exploit for gain-—
Now, what is the one thing that defines “for-profit”? That is right. Profit. Gain. A CEO has only one job---to post a sustainable profit for his company and its shareholders. Note that “sustainable” can mean anywhere from fifty years to six months—until a buyer can be found for the company. Meaning a lot of incentive for short term profit.
What happens to the short list of rules of medical professionalism if you are the CEO of a major pharmaceutical company or a for profit urgent care clinic or a durable medical goods manufacturer?
1. First Do No Harm Becomes Acceptable Risk. How many people can die when the product malfunctions in a way that it has been proven to malfunction and still allow the company to walk away with a substantial profit and its reputation (mostly) intact after the lawyers, pr folks and insurers are done?
2. Equal justice becomes Target Audience. Products can be priced up if they are marketed towards certain “select” groups. A designer urgent care in an all white suburban neighborhood can promote itself as “cleaner, safer, whiter” than the local emergency room where the “riff-raff” congregate.
3. The needs of the patient….Why are we even talking about this? Any CEO who put the needs of the customer (not patient) before the needs of the bottom line would be considered negligent by his stock holders. He would be fired. Sued. He might even be prosecuted for embezzlement or malfeasance. He has a duty to seek out and create cash profit where-ever and however he can make it. In the world of For-profit Health-care, the tenets of professionalism are replaced by the concept of “negativity”---with the “negative” health care provider being one who does something that might diminish the revenue stream.
For-profit health-care in this country is becoming a swamp. Companies take their own life saving drugs and devices off the market so that they can blackmail patients (customers) into paying them ten or one hundred times more to bring them back. There is no investment there. Just calculated greed.
Meanwhile, one of the best health-care systems in the world, the Veterans Administration Health System conducts research that really does improve lives, and when it comes up with new therapies, it gives them away, making no profit for itself. Because health-care is not about profit. It is about care.