The ethical nexus of health care: Purpose over profit

ACP is comprehensively examining the corrosive impact of profit-driven health care on the sacred patient-physician relationship in order to pave the way for potential solutions.

The canvas of human history is painted with the evolution of medicine and health care, a tapestry woven across time and cultures. From the ancient Egyptian, Babylonian, and Chinese civilizations to the intellectual blossoming of the Greeks, Romans, and Muslims, the foundation of medical knowledge took shape. The Renaissance and Enlightenment epochs introduced critical empiricism, setting the stage for evidence-based medicine. The 19th century witnessed scientific leaps, while the 20th century marked astonishing medical advancements, epitomized by antibiotics, vaccines, and intricate surgical techniques. With the World Health Organization's establishment in 1948, global recognition of health care's paramount importance was solidified.

Throughout this journey, a steadfast principle has persevered: the moral responsibility of tending to the sick and infirm, rooted in placing the patient's welfare above all. The profession of medicine is driven by an intrinsic calling, an earnest aspiration to ameliorate suffering, enhance well-being, and leave an indelible positive impact on individuals and communities. This noble calling is underpinned by empathy, compassion, and an unwavering commitment to uplift lives. Across cultures, societies have recognized the solemn duty to care for the sick, constructing health care systems that mirror these convictions. However, in the United States, provision of health care has been marred by discrimination and inequity, with adequate services granted to certain demographics while denied to others.

The confluence of the industrial revolution and technological innovation in the past century birthed an era of improved health and extended lifespans worldwide. The interplay of free enterprise and entrepreneurial zeal has propelled medical progress, translating into innovative breakthroughs that benefit populations. With this progress, societies strive to balance individual advancement with collective responsibility, especially in the sphere of health care. The intricate interplay of genetics, environment, and human biology, which fuels the genesis of various ailments, often lies beyond individual control. The reverberations of prolonged illness and untreated injury transcend the individual, affecting families, communities, and workplaces. Enlightened societies comprehend the indispensability of accessible and effective health care as a communal commitment, a pivotal intervention for collective well-being, prosperity, and contentment.

The United States was born from the aspiration to dismantle the devastating grasp of monarchical wealth and power. However, it continues to grapple with a disconcerting rift between its idealistic founding principles and its practical reality. Efforts were made in the early to mid-20th century to quell unchecked avarice and reestablish a fair balance. Yet, those entrenched in privilege continued to find avenues for profiteering, even co-opting lawmakers to perpetuate their self-serving agendas. Nowhere is this detrimental strategy more flagrant and destructive than in the realm of health care. The industry has adeptly crafted deceptive narratives to rationalize its exorbitant pricing. The elite who reap the rewards of this reprehensible exploitation remain oblivious to the suffering they cause, or at the very least, choose to ignore it. This ignorance, coupled with policy inertia, shackles any meaningful alteration of the status quo in an industry veering further from its ethical compass.

Once a noble calling, it now finds itself enmeshed in a web of deceitful business practices. The staggering costs of some health care institutions exemplify this distortion. Providing excessive treatments or unnecessary procedures, they add costs, amplify disparities, and diminish patient-centric care. The intrusion of profit-seeking private equity firms has exacerbated the situation, further distancing health care from its true purpose.

One glaring example is the pharmaceutical industry's artful orchestration of the opioid crisis, leaving devastation in its wake with negligible repercussions. Lifesaving drugs undergo inexplicable overnight price hikes, revealing a stunning lack of ethical restraint. The discordance between drug prices in the United States and their reasonable counterparts elsewhere underscores the ludicrous nature of this exploitation. These injustices, perpetuated by a system designed to favor the few at the expense of the many, find their roots in a landscape of legalized bribery, greed, and intimidation. The health insurance industry perpetuates this quagmire, coupling high premiums with the denial of life-saving treatments while channeling billions toward executive pockets.

In this labyrinth of commerce's conquest, health care institutions, both for-profit and nonprofit, have deviated from their raison d'être. The spiraling costs, overlaid with overtreatment and administrative redundancies, have facilitated financial gain rather than patient-centric care. A significant fraction of the nation's health care spending is siphoned off by hospital care, yet this expenditure fails to translate into equitable health care. Comparative data highlight the exorbitant nature of these costs in the United States. An elevated maternal mortality rate, coupled with dismal patient satisfaction statistics, paints a bleak picture of the nation's health care. Moreover, the ethos of health care institutions has been distorted, with management and compensation structures prioritizing executives and administrators over essential front-line caregivers. The moral injury inflicted upon clinicians and caregivers is palpable, a testament to the inversion of purpose that is reshaping the medical landscape. The result—a nation grappling with a remarkably low life expectancy relative to other developed countries—evinces the deeply flawed paradigm of the health care market.

The American College of Physicians has embarked on a path of introspection. We are comprehensively examining the corrosive impact of profit-driven health care on the sacred patient-physician relationship in order to pave the way for potential solutions and offer a transformative vision of a patient and family-centered, value-based, universal health care model. These evidence-based policy proposals illuminate a path toward mitigating barriers to care and addressing the escalating cost of health care.

At this juncture, our collective conscience is summoned to mend the moral fabric of health care. The interests of the American populace must triumph over profiteering. As we navigate through this nexus of purpose and profits, we must engage in a profound dialogue that elevates human welfare above capital gains. The synergy between the healing arts and societal well-being is an intricate bond that merits meticulous preservation. The future of health care hinges on our ability to restore its ethical soul, a journey that encompasses activism, policy transformation, and a collective return to the essence of care. Medicine and health care, at their core, are an ode to human compassion, a symphony of healing that resonates through time.