Battling the hydra of the medical-industrial complex

It seems every week there are more stories about the billions of dollars of profits announced by health insurance companies or other health care entities. It literally makes me feel sick. And then I feel angry.

The medical-industrial complex has become a monster. It is devastating to our patients, and it is devouring physicians at every level, physically, emotionally, and even intellectually. Smart minds have taken business models to the extreme in health care-related corporations. Decisions on resource allocation or new initiatives are driven by the critical concept of return on investment (ROI).

We physicians stand by, too frequently powerless, watching as budget items that we know are clinically necessary for better patient care don't get resourced and as other initiatives of dubious clinical value move forward, all due to the omnipotent ROI calculation. We cannot blame health care system executives solely for this ROI focus; they are merely playing by the existing rules of the game, dysfunctional as those rules are.

The rules must change. That will only happen by fighting the monster of the medical-industrial complex. The monster is like the mythical hydra, with many heads. In our quest to protect the patient-physician relationship as a critical priority, we must destroy the monster at its core and not just fight each of the heads as they continue to grow back. Each of those heads in a different way erodes patient care and weakens the patient-physician relationship, that sacred space out of which evolve compassionate care and trust.

Our patients find navigating the health care delivery system exceedingly difficult, if not impossible. And too often, physicians feel like widgets in the dysfunction that has become our system's status quo. We are tired not just of being called “providers” but also of being treated interchangeably with clinicians with far less training.

Not only do many of the health care corporate entities make unconscionable profits on the backs of patients, but they are now constantly developing new strategies to deliver health care in ways that interfere with those established sacrosanct patient-physician relationships. The underlying motive is not to improve care but to further bolster those short-term profit figures that Wall Street loves so much. Our patients deserve better.

We are entering a battle for the soul of American medicine. Our patients' health care is not a commodity, it is life and death. ACP established policy in the early 1990s advocating the necessity of universal coverage. Over the years, the College has expanded that position to include detailed policies touching on many areas of costs of care, delivery system reform, and payment system reform. Some components of our policies have been incorporated into legislative improvements. But with every progress, the hydra grows more heads (legal challenges, legislative or regulatory reversals, executive orders) that block the improvement or in many cases take us several steps back. Our patients deserve better.

We all know that too many of our patients are suffering due to inadequate access and affordability. The health care system has left them behind in tragic and immoral ways. And the physician workforce is struggling to do right by our patients to deliver the care they need in increasingly challenging and demeaning environments. And yet, the hydra continues to explode pronouncements of profitability. Our patients deserve better.

ACP leadership decided in July 2018 that it was time to develop a new vision for the future of American health care. The charge to our major health policy committees was to study how evidence can guide us to:

• achieve universal coverage and improve access,
• reduce costs,
• improve the dysfunctional payment system, and
• reduce administrative burdens and excessive complexity.

Through a prolonged process with wide input from ACP membership, this culminated in the release of a Jan. 21 Annals of Internal Medicine supplement “Better Is Possible: The American College of Physicians' Vision for the U.S. Health Care System.” Since we are now in early April, I hope that this is not new news.

These papers are remarkably comprehensive and thoughtful; I urge everyone to take the time to read them. The major conclusion was that ACP goals can be achieved via either of two paths: a public option within a system of regulated private insurance, or a single-payer financed system. ACP concluded, based on evidence from other countries and our own state systems, that a purely market-driven approach to health care delivery such as we and our patients are suffering with today does not meet the criteria set out for a system that works for everyone.

Many forces are changing health care delivery right now. We must make some honest assessments and clearly state certain observations and truths in the public space. Corporations of many types (insurance, pharmaceuticals, pharmacy benefit managers, and medical devices, to name just a few) are making millions and billions in profits that are pulled out of the health care system instead of being used to provide better care to our patients. We all know this and need to call it out.

The newest phenomena in recent years have been the entry of private equity and venture capital firms into the health care space and the expansion of pharmacy chains into retail health clinics. They see ripe potential to disrupt the dysfunctional status quo quasi-marketplace, increasingly treat patients like consumers, develop systems of improved efficiency, at least on the surface, and in the process destroy or undermine the patient-physician relationship. That final consequence might not have been an initial malicious motive, but it is a real systemic result that must be recognized.

The deterioration of patient-physician relationships due to market forces might be simply an academic point, until one cannot find a physician in a time of need. Yet in the present, the allure of making quick big profits in the current chaos of the health care system is simply too great for the sharks to stay away.

The disinformation media blitz has already begun. Organizations with altruistic-sounding names such as Partnership for America's Health Care Future, a coalition representing insurers, pharmaceutical companies, and hospitals, assert that we should “build on what's working in our health care system.” Do you remember the success of the Health Insurance Association of America at turning public opinion against the Clinton health plan back in 1994, using its year-long advertising campaign of “Harry and Louise” commercials in which a couple expresses dismay at their dwindling insurance options and rising costs? We should expect a new generation of that type of commercial in the near future.

If we are to battle this hydra, consider the media blitz just one of these growing heads. We need to empower our patients and to call messages out as propaganda. If an organization or political action committee has a patriotic positive name and urges support for the status quo, then beware. Remind your patients that the status quo is extremely profitable for this medical-industrial complex hydra, which will use deceptive and devious tactics. But the status quo does not serve our patients or our ability to practice medicine to our fullest potential.

The College has taken the bold stance that the status quo is unacceptable. Hercules' Second Labor was to destroy the hydra, and we will need all the physician and patient forces we can recruit in our own herculean effort. Help us in our battle. Our patients deserve better, and we know that better is possible.