Money Drives Medicine
By
Leonard Zwelling
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This article appeared in my email inbox on December 12 from The New Yorker. It was titled “The Gilded Age of Medicine is Here” by physician Dhrub Khullar. And the title of this blog is the subtitle of my novel Conflict of Interest about this very topic.
The New Yorker article is what you think it is, a long piece about how medicine has become big business and how venture capital funds are purchasing health care facilities and doctors’ practices in an effort to turn a profit. The article discusses the adverse effects of Medicare Advantage plans on patient access and care costs. It also goes into some depth about how putative non-profit providers of health care turn huge profits and still get tax breaks.
It always struck me as strange that places like MD Anderson were considered non-profit yet always talked about making a margin, particularly by having a high-cost charge master (list of services and prices) for the rare cash-paying patient, driving hard deals with insurers for payments, and reveling in the DRG exemption afforded Anderson by the federal government which guarantees a favorable payment for the care of Medicare patients, a large proportion of cancer patients.
In addition, doctors are being asked to see more patients in each clinic session and to do so by carving out fewer minutes for each patient.
It seems that most of the doctors I see for my own care and the younger doctors I speak with have made the accommodations needed to deal with this new system. But, have they?
Apparently, burnout among physicians is at an all-time high. Medical school graduates are avoiding high pressure specialties like primary care and many more patients are avoiding the health care system entirely until they get really sick and have to use emergency facilities because they fear going broke from being charged for expenses not covered by insurance. It is safe to say that this is no way to run a health care system. In fact, America does not have a health care system. It has a disease care system.
Robert F. Kennedy, Jr., the secretary-designate of Health and Human Services, advocates for more healthy life styles as the cure for what ails us. That’s fine, but in the meantime even if more than half of Americans follow his lead to lose weight, stop drinking, and cease smoking, doctors still have sick, overweight, addicted patients to see.
If Mr. Kennedy really wanted to make a difference, he would incentivize medical students to enter careers in primary care by paying for their medical education if they pledge to do primary care and do it preferably in a community of health care need. He would pour money into medical education to increase the size of medical school classes to alleviate the doctor shortage. In addition, he would educate children in elementary school about what health is, how to eat well, how to cook in a healthy manner, how to put down the video game controller and exercise, and finally how sex and sexually transmitted diseases work. Home economics, shop, and gym all need to return to the school curriculum.
Given the nature of Mr. Kennedy’s past history of prevarication about vaccines, and his general lack of any health care credentials, this all seems unlikely.
Health care is now big business and doctors simply cogs in the machinery of large-scale capital investment with little concern for patient welfare. We may well be stuck with this corporate culture and patient-centered care becoming a phrase with no meaning.
If, as I fear, the new Trump health care team begins to chip away at research funding, that innovation they like to attribute to big pharma may go away, because most of those successful new corporate drugs are based on basic science funded by the NIH.
The next few years should be interesting times in health care. Whether they will good for patients or doctors has yet to be determined.
4 thoughts on “Money Drives Medicine”
Dr. Zwelling, thank you for continuing to speak up about the corporatization of medicine and the relentless squeeze it puts on providers and patients. I’ve lived these failures firsthand—a fun little side effect of questioning the system—and let me tell you, it’s a front-row seat to the worst show on earth. After losing my faculty position at MD Anderson to professional blacklisting, I experienced in a new and painful way how deeply systemic pressures erode the well-being of both providers and patients. You can read more about my nightmare of a story here: https://www.gofundme.com/f/support-shields-strong
I often wonder how far the pendulum will swing before the whole thing collapses under its own weight. James Baldwin managed to capture it perfectly: “The price one pays for pursuing any profession or calling is an intimate knowledge of its ugly side.” There’s a troubling pattern I’ve seen repeatedly among my physician peers who finally find the courage to ask for help for “burnout” (which, let’s be honest, is often just a reasonable response to systemic dysfunction)…
• The State PHP that promises “confidential support” but quietly shows them the door.
• The administrator’s “no discrimination” policy—until their need for help becomes a liability.
• Their EHR record conveniently synced with their employer’s risk management team, where privacy is apparently a “loose” concept.
These realities—and now, my own firsthand experience—have pushed me to rethink how I support my peers. I’ve been rebuilding my practice as a clinical psychologist, informed by my work in ethics, to create a space where seeking help isn’t a career death sentence. I’ve chosen to step away from EHR systems entirely—transitioning to paper-only records, maintaining minimal documentation for those who prefer it, using diagnosis codes only when absolutely necessary, and of course, staying independent of insurance. I’d love to hear your thoughts on other ways we can reduce barriers to physicians accessing quality care.
I sincerely appreciate your willingness to continue sharing your voice. Despite the seeming futility, this is a conversation we cannot afford to stop having.
That is quite some story and you have my deep sympathy. I cannot say that I am surprised for a few reasons. Medicine has become corporatized. Money is everything. People, including doctors, are just cogs in the machinery. The irony is that we doctors let it happen. We could have stopped it long ago by unionizing and boycotting changes like the EMR, the 15 min clinic visit, and the advent of lawyers as answers to all problems in health care. Alas, too late now. Medicine is no longer quite the honorable profession it once was, which is too bad.
The only way this stops is if doctors stop it, but most are too afraid of losing their compensation and benefits to act. I have long since given up. I am grateful that neither of my children are doctors. I work hard to find good care for myself and my family. It is not easy.
I’ll keep writing. My novel Conflict of Interest touches on much of this and my book Congressional Malpractice shows how Congress is completely dysfunctional.
I am no longer in the fight myself on a day to day basis. I must say, I don’t miss it.
Your suggestions for the next Secretary of Health and Welfare are right on! RFK Jr is obviously NOT the person to lead that change. If not him, then who? The leaders of our major medical and surgical associations need to be at Trump’s doorstep with money and with suggestions. Make Trump think that he will be remembered for improving the healthcare of Americans, something most Presidents, with the exception of Obama, have failed to achieve.
Yep. I do not think that Donald Trump will be the health care president. I don’t think it is on his radar screen