Profiteering the Medical-Industrial Complex Way

        

              

Sixty-four years ago in his parting speech, President Eisenhower warned us about the Military-Industrial complex. Twenty years later in 1980, Dr. Arnold Relman, longtime editor of the New England Journal of Medicine (NEJM) cautioned us about the Medical-Industrial Complex.

What were these wise men afraid of?

What were they trying to tell us?

President Eisenhower’s concern was that world leaders would continue to create adversarial relationships between governments so that they could profit by making war machinery. Dr. Relman was similarly concerned about profiteering in the healthcare industry. Now, profiteering by war and by illness have come front and center stage.

Now the only issue is what do we do about it. Dr. Relman was worried about overuse and fragmentation of healthcare services, with over-emphasis on technology. He believed:

“closer attention from the public and the profession and careful study are necessary to ensure that the medical-industrial complex puts the interests of the public before those of its stockholders.”

Ten years later, in Modern Medicine: What You’re Dying to Know, I wrote about the problems I saw developing in the practice of medicine. One of those problems was the increasing corporate hijacking of medicine. Please feel free to read an excerpt from this book, Chapter 1, Big Business Greed.

I’ve also written here on Substack about big business medicine’s destruction of the physician/patient relationship, the control of physician decisions by Big Pharma, and the disappearance of primary care physicians. All problems related to the corporated control of medicine.

At that time we wrote the book, I believed consumers could put pressure on their congressional leaders to try to keep medical decisions in the hands of their physicians, but they could not. It was nearly impossible even then for consumers to understand their hospital bills.

The takeover of physician care by corporations marched on.

Dr. Relman thought the solution to corporate control of medicine was the nonprofit hospital. Today we have mostly nonprofit hospital organizations, but the medical-industrial complex that Dr. Roman so worried about has simply morphed into not-for-profit fronts for organizations which make decisions based upon the bottom line, not quality healthcare.

While doctors work hard for $250,000 a year, the corporate medicine Chief Executive Officer (CEO) is a busy raking in 12 million dollars or more per year. The CEO of the pharmaceutical company CVS makes $22 million a year. The average employee of CVS makes somewhere between $30,000 and $50,000 a year. And of course, CVS has collected enough profits to buy Aetna for $75 billion dollars. Simultaneously, well, these large not-for-profit chains are making money hand-over-fist, 50 percent of consumers have some medical debt and a large percentage have lost their homes.

Unfortunately, Relman’s suggested solution is now the cause of the problems with the Medical-Industrial complex. The so-called not-for-profit medical organizations suck large amounts of money out of communities, both rich and poor, by the typical big business solution, restricting consumer care. Medicare and Medicaid are no exceptions.

Depriving consumers of care is not a good solution. In the first place, the people who do the depriving earn salaries which are quite large. Secondly when patients can’t get cheap care early, they get expensive care later, along with unnecessary pain and suffering. In healthcare, A stitch in time really does save nine.

When Dr. Relman was in the hospital as a patient, he noticed how the electronic health record (EHR) interfered with healthcare in general, and the doctor-patient relationship in particular. About this issue Dr. Relman was right. The EHR definitely interferes with delivery of medical care. The younger doctors don’t seem to be bothered so much by this, partly because they have a better facility with computers, but the other problem is that when medical care was more effective, before the advent of computers in medical care. these younger doctors were still in diapers. So they have no frame of reference.

Dr. Relman’s suggestion that non-for-profit hospitals could help slow down the taking over of community hospitals by corporations has not come to pass. The corporations have simply put on the mask of non-profits and the run their non-profits as businesses, not as providers of what is essentially a community service. As I noted in Modern Medicine:

State and federal legislators have within their power the ability to stop lage corporations from decimating small hospitals and small communities by closing portions of small hospitals, including obstetric units. The problem of obstetric deserts depends largely on the destruction of small, community owned hospitals. To remedy this situation, we need our legislators to represent the people they are supposed to be representing, the people in need of a public good, not a salable commodity.