May 19, 2024

Is America’s healthcare system a kleptocapitalist nightmare?

American health care is perishing under the weight of its greed, according to an editorial in JAMA by Donald M. Berwick, a well-known former administrator of the Centers for Medicare and Medicaid Services (CMS).

In an essay titled “Salve Lucrum*: The Existential Threat of Greed in US Health Care’, Berwick argues that

The grip of financial self-interest in US health care is becoming a stranglehold, with dangerous and pervasive consequences. No sector of US health care is immune from the immoderate pursuit of profit, neither drug companies, nor insurers, nor hospitals, nor investors, nor physician practices …

Profit may have its place in motivating innovation and higher quality in health care, as in any industry. But kleptocapitalist behaviors that raise prices, salaries, market power, and government payment to extreme levels hurt patients and families, vulnerable institutions, governmental programs, small and large businesses, and workforce morale. Those behaviors, mostly legal but nonetheless wrong, have now accumulated to a level that poses an existential threat to a sustainable, equitable, and compassionate health care system.

Comments on his eloquent anger by readers of JAMA were varied. Most were supportive, but others supported the free market in the provision of healthcare: “Excessive prices and waste in medical goods and services in the U.S. is [sic] due to unnecessary government intervention and third-party involvement in payment. These things are controlled to some extent elsewhere by rationing. Greed will never be removed from human interactions. What keeps it in check is free competition.”

*Salve Lucrum is a Latin phrase meaning “hail, profit!”