Lancet Panel on Investor-Owned Health Care

Summary: The recent Lancet webinar on private for-profit ownership of US health care assembled leading experts on this crucial issue. We must – and can – reverse this commoditization of health care. Public policy and health in the USA: should investors own healthcare? https://www.thelancet.com/webinars (scroll down to “On-demand webinars”) The Lancet Webinars Sep, 2023 Claudia Fegan: The question of “Should investors own healthcare,” I believe is the most important policy question facing healthcare in the United States today. We spend over 4 trillion dollars a year, 18 percent of our gross domestic product is spent on healthcare in the U.S. each year. That is more than twice as much as most other developed countries. Yet we rank miserably in the outcome measures such as life expectancy, preventable hospitalizations, maternal mortality, and suicide. We need to ask what role in the U.S. the current investor-driven system plays in causing and exacerbating the racial disparities in healthcare. Donald Berwick: In the past few years I’ve tried to understand how such a noble system can be so underperforming in its potential at the cost of the well being and spirit of the work force and the patients it serves, I have come to use the word GREED, and I’ve been challenged for that because most of the people that work everyday in all of the sectors of healthcare feel quite good about what they’re doing, they’re trying to help patients. But when we look at the underlying dynamics, I believe the commoditization, commercialization, the role of changing ownership to private hands, and the proletarianization of the healthcare workforce lie at the core of at least some of the reasons why this system is so deeply underperforming. You cannot find a sector in healthcare in which greed is not just manifest, but I would claim even dominant. Greed right now effectively concentrates wealth in the United States; wealth concentrates political power and influence through the role of lobbying and political contribution, and that political contribution stops efforts to reign in or place constraint on greed. Rosemary Batt: Private equity turns healthcare from a social good into a financial asset. It extracts wealth through financial strategies and not primarily by providing better care. There may be some improvements in care, but the fundamental focus is on financial gain. (She explains the mechanisms that private equity uses for wealth extraction.) Steffie Woolhandler: What we’ve seen is what I’ll call financialization of the entire healthcare system: money has become the mission. Traditionally providers invested money in buildings and equipment in order to produce medical care. That was our service mission or social mission. Now, financial entities are investing in medical care to produce money through profit, and money is their mission, and that, fundamentally, is what is wrong with the U.S. healthcare system today. This is happening despite the fact that the majority of the American people do not want this. Polls continue to show that the majority of the American people want a nonprofit, single payer, Medicare for All system for the United States. But Medicare for All is not enough. We need to address ownership, and we need to take back hospitals, community resources, the doctors’ practices, we need to take them back from investors and return control to community providers and patients (see HJM post on The Nation “Medicare For All Is Not Enough”). Q & A: Don McCanne: Is there any prospect that the United States could have a progressive legislature and administration that would support a healthcare financing system exclusively devoted to the service of universal patient care rather than being devoted to private wealth? Steffie Woolhandler: Absolutely. There’s that possibility. Other nations have succeeded in establishing non profit, publicly owned, sometimes publicly regulated and publicly administered systems. If they can do it, we can do it. It’s just going to take a lot of organizing and a lot of educating the public about the possibility. Donald Berwick: I’ll add that we are the outlier. Every other country finds a way to guarantee care to everyone – every other developed country – at a cost of about half of ours. So no-one can say, “it can’t be done.” It’s a matter of will, and I fear nowadays it’s a matter of political will. Comment by: Don McCanne This excellent one hour webinar by The Lancet explains why single payer alone is not enough. Not only do we have to establish an equitable, affordable financing system that makes healthcare accessible for all (single payer), we are going to have to address the issue of ownership of the healthcare delivery system such that our healthcare dollars that derive from us, the people, end up serving the public, social mission of providing healthcare for all instead of the private mission of enhancing personal megawealth for the few. The notice of this Lancet webinar should be distributed to all who care, and to those who don’t now seem to care but may have within them the capacity to care when the facts are understood. Whether nominally public or private, it’s our money; let’s spend it on us.