August 8, 2024 – In a July 29 opinion piece in the CommonWealth Beacon, John McDonough, professor of public health practice at the Harvard TH Chan School of Public Health, wrote about how profit-driven decisions are companies including Steward Health Care, UnitedHealth Group. , and the drugstore chains Walgreens and CVS, are disrupting medical care in Massachusetts. Here, he explains how the situation got worse and how it can get better.
Q: Are for-profit drugs inherently problematic?
A: The power of profit has always existed in American medicine, along with conflicts of interest. For example, in the 19th centuryth century, some doctors pushed drugs and cures with no evidence that the cures worked. They were doing it to make money. The nursing home and pharmaceutical industries have always been very profitable.
Financial malfeasance in US health care reached a different level in the 1970s and 1980s, with the rise of what Arnold Relman, a recent editor of the New England Journal of Medicine, called the rise of the “medical industrial complex,” when we see violent people. entering pharmaceuticals for profit corporations with shareholders. From then on, the problem has been this: If the primary obligation of for-profit companies is high returns to their owners, and the primary obligation of medicine is patient-centered care, you has two owners. This conflict has never been reconciled—because it is irreconcilable.
Q: Can you describe what happened with Steward Health Care in Massachusetts?
A: Steward Health is a for-profit hospital system created in 2010 after Cerberus Capital Management, a private equity firm, bought the struggling Caritas Christi hospital chain from the Archdiocese of Boston. Until 2015, Cerberus was under the supervision of the Massachusetts attorney general. In 2016, Cerberus sold Steward’s buildings and assets to a real estate investment trust (REIT), Medical Properties Trust, using the proceeds to buy more hospitals outside of Massachusetts and enrich its investors. From then on, the hospitals, which previously owned the land they stood on, had to pay exorbitant rents to the REIT.
In May, Steward filed for bankruptcy protection, and in July announced that it would close two of its Massachusetts hospitals—Carney Hospital in Dorchester and Nashoba Valley Medical Center in Ayer—at the end of August. .
Q: Is there anything the state of Massachusetts can do to address Steward’s situation?
A: The country is doing something. Their plan is to advance $30 million in Medicaid payments to facilitate the sale of Steward’s six remaining customer-owned hospitals. As for the two hospitals slated for closure — Carney and Nashoba Valley — some have suggested they be put into a federal receivership, though it’s unclear whether that would make a difference if no qualified entity wants to buy them. . The Healey administration is reluctant to take on an uncertain commitment.
Q: What is the problem with UnitedHealth Group?
A: In 2022, UnitedHealth purchased a former nonprofit physician and health center called Atrius Health. Atrius is now part of the largest profitable healthcare company in the history of the country. They reduce costs, shorten the time you can see your doctor and eliminate services. They get their doctors to see more patients for shorter visits, all for the benefit of their shareholders.
Q: What happens to pharmacy chains?
A: Chains close the spaces. CVS is the largest chain. It has its own pharmacy benefit management firm, which has been exposed in the New York Times and the Wall Street Journal in the past few months for conducting operations that undermine health care access and drive up costs. of prescription drugs for consumers.
All of these factors – the closing of hospitals, the squeeze on doctors’ and nurses’ time with patients, and the closing of pharmacies as drug costs continue to rise – add up to indicate a healthcare system that is losing its soul and turning aggressively to make a profit at a cost. of the patient’s needs.
Q: Do you see any hope that the nationwide issue of for-profit medicine can be resolved?
A: The scandal of for-profit medicine cries out for solutions at the state and federal level. Now, nothing can happen at the Congressional level because of the divided government. We will see how the election will follow on November 5.
Important to take effective action is the Federal Trade Commission (FTC) and the Antitrust Division of the US Department of Justice (DOJ). For example, I would like to see the FTC and DOJ break up UnitedHealth into separate companies, including an insurance company, a health services company, and a pharmacy benefit company.
We didn’t get to this point overnight and it won’t change any time soon. And history teaches that determined and consistent action by the federal government can make a real difference.
Antitrust is important because the centralization and control of society in American society has completely infected US medical care. Everyone who cares about the future of our health care system has a stake in this fight.
– Karen Feldscher
Photo: iStock/shipov
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