February 7, 2023

The journal JAMA published a Viewpoint on Jan. 30, 2023 by Donald Berwick, MD, MPP, entitled Salve Lucrum: The Existential Threat of Greed in US Health Care.

In it, Dr. Berwick contends:

“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.”

The problem Dr. Berwick identifies has a human cost:

“A total of 41% of US adults, 100 million people, bear medical debts. One of every 8 individuals owes more than $10 000. In Massachusetts, 46% of adults say they skip needed care because of costs. As of 2021, 58% of all debt collections in the US are for medical bills.10 Health insurance premiums in Massachusetts have gone up more than 200% in 2 decades and now cost more annually per family than a car. People of lower income must choose high-deductible plans; they cannot afford more complete coverage. In no other developed nation on earth is deep medical debt as present a threat as in the US.”

Dr. Berwick suggests some solutions that require leadership from healthcare professionals, some of whom are participants in the paean to excess profit that he identifies, including:

– “First, health care professionals in all disciplines need to become noisier about the conflict between unchecked greed and the duty to heal.”

– “Second, health care professionals should insist that their guilds and trade organizations demote the pursuit of higher payment among their priorities.”

– “Third, health care leaders and professionals should lobby Congress to pass legislation to rein in greed.”

– “Fourth, health care professionals should insist that their organizations invest actively in improving the true social influences on health.”

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

Page last updated Feb. 7, 2023 by Doug McVay, Editor.