REVENUES OVER LIVES: health professionals' role in challenging the "medical-financial complex”

Socially-conscious health professionals of all ages need to attack the inhumanity and economic injustice that persists in health care.

I graduated medical school a half century ago, and in the decades that I practiced family medicine, medical science and medical technology advanced considerably. But justice in our health care systems has stagnated. Young health professionals are needed to advance justice, and especially to make health care affordable for all.

As George Santayana once said, “Those who cannot remember the past are doomed to repeat it.” Why has Americans’ health deteriorated in comparison with the residents of other prosperous nations, while our health spending grew to twice theirs?

The creators of Medicare developed their strategy when I was in grade school. They succeeded when I was in college. They believed that creating universal coverage for the neediest group, the uninsured elderly, was like putting the proverbial camel’s nose under the tent. The success of Medicare would lead in short order to other age groups being added to the plan.

Sadly, policies always have unintended consequences. Medicare and Medicaid did improve health for many of the elderly and the poor, but at an unexpectedly high cost.  By the time I graduated medical school, the big issue wasn’t which age group to add next, but how to control health care spending.

Politicians chose to trust corporations – leading to a proliferation of varieties of and names for managed care, but scant success.  Since the beginning of the 21^st century, medical inflation has been 55% higher than general inflation.

One of the cruelest aspects of American health-care economic injustice is out-of-pocket spending. Plans with high deductibles are often the only insurance that low- and middle-income families can afford.  The problem is that if they get sick, they go broke or cut back on needed health care or both. Unaffordable deductibles add insult to injury. 

Out-of-pocket spending for health care services by low- and moderate-income patients is a small part of overall American health care spending. Those who are making big bucks in health care will not go bankrupt if they don’t receive cash from those who don’t really have it. 

Challenging the medical-financial complex

When I was in high school, President Eisenhower’s farewell address warned that we were creating a “military-industrial complex.” At that time, national health care spending was less than military spending. Later, in 1980, the New England Journal editor Arnold Relman warned about a different risk, the “medical-industrial complex.” Now, national health care spending is more than three times military spending. 

What we have now is best described as a “medical-financial complex.” Just about every component of the medical sector is more focused on maximizing revenues and/or profits than ensuring quality care for all. 

Health care isn’t seen as a noble public service, but as a source of income. 

Every practicing clinician has many stories of patients whose health unnecessarily deteriorated because they couldn’t afford needed care.  Clinicians in equally prosperous but more civilized nations rarely hear these stories.

We need to make American health care USA – Universal, Simple, Affordable. A variety of policy approaches could get us there. Some nations, like the U.K., use a “national health service.” Others, like Canada and Taiwan, use a “single payer” model. European nations commonly use regulatory approaches sometimes called an “all payer” model. The major difference between us and them is that for decades, they have seen health care as a social good, a public service, a necessity that all deserve.  

What a military-industrial complex or a medical-financial complex has is the political clout to keep public money flowing into its private coffers. Vision documents from all major American medical societies and hospital systems reference their beliefs in quality care for everyone. But most of their lobbying and outreach to public officials is to assure or to increase their revenues.

To shrink the power of the medical-financial complex, opposition needs to come from the inside as well as the outside. The youngest generation of health professionals needs to lead the fight with a values-based approach. Socially-conscious health professionals of all ages need to attack the inhumanity and economic injustice that persists in health care.

Policy technicians can develop a variety of approaches to make health care affordable to all. The fight to enact them won’t hinge on policy cleverness. This is more than a policy fight; it is a values fight.  Opinion surveys have shown that Americans of all political persuasions believe that health care must become affordable for all, but the power of the medical-financial complex is assured as long as hyperpolarization and grievance politics flourish. 

In my past, younger generations played a leading role in the fight for Civil Rights. They are currently doing vitally important work in clean energy and gun control. Those who have chosen a health-care career need to push hard for health-care justice in general and for reducing or eliminating the painful and useless burdens of excessive out-of-pocket spending. 

Dr. Kenneth Frisof, MD is a Family Medicine Specialist in Cleveland, Ohio, and has over 50 years of experience in the medical field. Frisof is a member of Doctors For America — an organization that advocates at a state and federal level focusing on access to affordable care, community health and prevention, and health justice and equity. Frisof also represents Doctors For America on the Center for Health & Democracy’s Lower Out-of-Pockets NOW Coalition’s steering committee.