American healthcare is infamous; the squeezing of dollars, wearing down of patients, layers of bureaucracy and managing of care. The problem is institutionalized, systemic greed. Extreme bottom-lining. It’s been normalized. The medical industrial complex is an affiliation of profit-making and purportedly nonprofit entities, but the system’s incentives, innovations, devices, drugs and adjacent services run on dollars. With management consultants and private equity involved, the layers of greed have created a hamster-wheel of hardship for many women. There's no question, greed hurts women's health.
As Dr. Elizabeth Rosenthal wrote in her groundbreaking 2017 book, An American Sickness: How Healthcare Became a Big Business and How You Can Take It Back, there is no single culprit, there are many. Neither hospitals, drug companies, medical device makers, some doctors or medically “adjacent” companies (like ambulance services providers) are resistant to greed. The morals of the marketplace, such as they are, govern. Treatments, guidelines, medications and testing are all subject to the laws of commerce.
Healthcare is Investor-Driven
The stock market tells a story. A peek into the S&P 500 index reveals a stark truth: healthcare stocks as a category rank second in terms of revenue and profits, second only to the technology sector. The healthcare category includes pharmaceutical companies, medical equipment and device companies and entities that conduct medical research. For-profit hospitals, dialysis centers, imaging centers, rehab facilities, in-home health companies are largely investor-backed. Healthcare is a huge business; an engine of prosperity for investors.
Administrative Costs Siphon Dollars
Electronic health records are just one example of administrative costs that ultimately get passed on to patients. There are layers of products and services adjacent to healthcare which are positioned to provide a revenue stream for founders and backers. Medical devices and technology solutions abound. From specialized syringes to ultrasound gel warmers, the innovations continue. While there’s no question that scientists and businesspeople are working hard to improve patient outcomes and that many have the best of intentions, it is also true that most of the entities they work for are under pronounced pressure to create lucrative outcomes.
Big Pharma Greed
The Big Pharma piece of the puzzle has been well documented. American consumers and our government have long subsidized the prices of pharmaceuticals, absorbing most of the research and development costs while single payer system countries negotiated successfully for lower prices. But it’s worse than that. Beth Macy’s hard-hitting book, Dopesick: Dealers, Doctors, and the Drug Company That Addicted America, exposed the abject greed of Purdue Pharma and its owners, doctors and employees who got caught up in the madness. As the book expressed and the Hulu series dramatized, this not only made people rich off of the suffering of others, it cost many lives. Then there's the semaglutide/tirzepatide arms race. Pass the popcorn.
Insurance Company Greed
Insurance companies do their own profit maximization. To start, the process of prior authorization is used as a significant bureaucratic challenge to the delivery of important care when it is needed. People take no for an answer and insurance companies avoid covering treatments, medications and procedures. Another thing health insurers do is a “fail first” technique; doctors and patients are often forced cheaper drugs first and prove that they didn’t work before more proven, though expensive solutions are approved. The biggest avenue that medical insurance companies use in denying treatment is the “medical necessity” standard. Insurance companies routinely invoke this in an overinclusive way, denying treatments, medications and procedures that should be approved, knowing that appeals are cumbersome for patients. I cannot accurately count the times I have assured a woman I’m advocating for that a bill or a denial she has gotten is not the final word. But health insurance companies understand that many patients will give up and pay out-of-pocket or skip care. They count on it.
How Greed in Healthcare Affects Women and What We Can Do About It
The stories of “pay out-of-pocket or go without” have hit so many of the women I have advocated for. Greed and the medical apartheid that it engenders makes women feel unimportant, locked out and irrelevant. Often women are givers, nurturers and community builders. Trained to be conflict-avoidant. This system was not built for people who approach the world from those vantage points. It is made of meaner stuff, designed by the patriarchy.
While doctors, employees, hospital administrators and entrepreneurs can all play a role in dismantling the grip that greed has on our healthcare system and I believe necessity will eventually force this result, women, the gatherers, givers, culture keepers and role models can start the necessary revolution, one pair of confidantes at a time. We need a compassionate revolution, a paradigm shift, where we employ the buddy system. Where no woman goes this alone. Where we walk in empowered with information and the power of empathy and companionship. It’s on all of us to help one another navigate and advocate. We can do it!
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