This may sound radical, but it’s not. An analysis of all urban acute-care hospitals in the United States found that most clearly favor lucrative procedures, like cardiac catheterization or surgery, over poorly compensated but critical services like psychiatric care, and for-profit hospitals have been found to perform C-sections, which pay better than vaginal deliveries, more often than nonprofits.
In other ways, nonprofits do no better: An investigation by The New York Times found that many nonprofit hospitals routinely engage in predatory billing practices, at the expense of their charitable mission. Last year, the nonprofit hospital that I worked for in New Mexico terminated all of its emergency physicians and brought in a for-profit corporation, owned in part by a private equity firm, to replace us.
Private equity’s entry into health care is only the latest and most extreme manifestation of a long-standing architecture. Among the board members of top academic medical centers, fewer than 15 percent have a background in health care. Most have worked in investment banking, or real estate. They speak the language of finance and business, and have never laid hands on a patient. The system prioritizes revenue because the leaders we’ve chosen have programmed it to do so, according to what they know. A team of social scientists, writing in The New England Journal of Medicine, calls it the “financialization” of health, in which care delivery is transformed “into salable and tradable assets from which the financial sector may accumulate capital.” According to the American College of Physicians, “what many imagine to be a lean, market-based system” is, in truth, “increasingly directed toward generating profit.”
