Medicine has changed. We used to be a calling that catered to the public welfare, and our prime consideration was the patient. Now we are a business, and some of us practice as impersonal corporations, with the bottom line the profits, not the well-being of the patient.”
— From The Doctor, by Dr. Edward E. Rosenbaum, 1991
The most shocking thing about the neoliberal health care model is not that it bankrupts and murders hundreds of thousands of Americans each year, but that vast numbers of physicians continue to support it. The insatiable depravity of the anti-single-payer virus has metastasized throughout every organ of the American teaching hospital, an institution which has betrayed its sacrosanct purpose, and which increasingly inculcates residents with the pernicious idea that good health care is a privilege and not a right.
The teaching hospital has become a dangerous place, not only for patients, but also for trainees, who are being forged into physicians without having been inculcated with a respect for basic principles of medical ethics. In this way have American physicians largely been reduced to an army of automatons trained to make money for the medical industrial complex. Indeed, it should come as no surprise that many residents lose themselves in a pitiless sea of soulless careerism, as they are immersed for years in an environment where they are beholden to, and at the mercy of, rapacious interests that place profit-making over all other considerations.
The teaching hospital is to health care what the ballet academy is to ballet and the music conservatory is to the symphony orchestra. All who covet this career must pass through its gates, and the values it imparts to its pupils form the basis of the light — or the inexorable darkness — that will assuredly follow.
Knowing that patients are often confined to extremely narrow networks, it is standard practice for teaching hospitals to arm-twist patients with inferior insurance into being medical models during physician office visits. This underscores the sociopathy of the contemporary teaching hospital, and serves as a metaphor for how these institutions have become inhuman machines that harm patients and sully the souls of their trainees. Cornell Dermatology, a department that could win an award for teaching residents how to coerce patients with inferior insurance into being clinical teaching tools, takes great pride in their villainy, writing on their website:
In addition to basic and clinical dermatology training, we strive to instill ethical behavior, compassion, communication and the recognition that we are here to serve our patients.
Residents that are the most amenable to the dictates of unscrupulous attendings position themselves to become chief resident or to be awarded a prestigious fellowship. In the American teaching hospital, this is the only thing on the mind of most trainees.
It is incontrovertible that the multi-tier system, the spawn of privatized health care, is incompatible with the oath to do no harm. Cornell Oncology, which once assigned me to a fellow due to my unglamorous insurance, writes on their website that “We care for the whole person and put the needs of our patients at the center of everything that we do.” Despite a blatant predilection for medical Jim Crow, Weill Cornell claims in their literature to have “a legacy of putting patients first.” In actuality, American teaching hospitals put profit-making first, research second, the attending’s comfort (vis-à-vis their desire to have a medical scribe or chaperone present in the examination room) third, the teaching of the trainee fourth, and the patient last.
In “I am a physician and I am not your enemy,” by Megan Gray, MD, the author laments the fact that her patients are wary of doctors. “I am asking you to trust that every day I put your needs above my own,” she writes entreatingly. It is possible that Dr. Gray does, in fact, put the needs of her patients above her own. Regrettably, this is often not the case, as evidenced by the fact that American physicians wrote over two hundred million prescriptions for opioids each year from 2006 – 2016, millions of our countrymen have been made addicted to psychotropic drugs, while Vioxx took the lives of roughly the same number of Americans as died in the Vietnam War.
It is clear that the physician-patient bond, regarded as inviolable for millennia, cannot coexist within the mores of privatized health care. Yet many doctors would argue otherwise. In “Being a doctor is not what it used to be,” by Raviraj Patel, MD, the author writes that “in my humble opinion, the patient-physician relationship is sacred, and the entire system is designed to facilitate that relationship.” In “To combat COVID-19, we endanger our doctors in training,” Gali Hashmonay, MD, writes of our uniquely dysfunctional for-profit apparatus, that “This system attracts doctors in training who are eager to put a patient’s well-being in front of their own.” Indeed, accepting gifts from pharmaceutical companies, performing practice pelvic exams on anesthetized patients, not disclosing long-term chemotherapy side effects, getting patients addicted to drugs (formerly benzodiazepines and barbiturates), imposing unwanted observers on patients during their physician office visits, pushing unnecessary surgeries, and ignoring do not resuscitate orders are some of the many things that residents have to look forward to when training at our esteemed teaching hospitals. After the corporate lexicon of “humanism,” “patient-centered care,” and “compassion” are stripped away, blind obedience is the attribute most coveted by teaching hospitals when interviewing prospective residents.
By refusing to acknowledge that corporatization has been a catastrophe, anti-single-payer physicians have sacrificed their autonomy to the devilish whims of the private health insurance companies, which have usurped the medical decision-making process. They have also sold their souls to the pharmaceutical companies, which continue to corrupt medical knowledge and foment quackery; and to hospital executives, who treat doctors as if they were employees at an investment bank.
The successful Cuban response to the pandemic underscores the fact that money and technology are useless when profits are placed over human lives. Vietnam, also a poor country with limited resources, has likewise mustered a stronger defense against the virus than the Beacon of Liberty. Cuba’s health care system is so robust that they have continued to send teams of doctors abroad, even in the midst of the pandemic.
Successfully completing a residency is analogous to being awarded a black belt in karate. Without a sense of compassion and virtue, such an individual is destined to become a danger to themselves, and a danger to others. As profiteering and the multi-tier system have become normalized in the American teaching hospital, this can only result in the commodification of the patient in the mind of the debased trainee.
In “5 things that make U.S. health care great,” by Suneel Dhand, MD, the author posits, without satire, that “A homeless American entering the doors of a hospital with an acute medical issue — be it sepsis, a myocardial infarction, or a stroke — will get better care than a rich person almost anywhere else in the world.” Writing for KevinMD, Kent Holtorf, MD, concedes that “The U.S. far exceeds any nation in expenditures for insurance administration, where the essential means of cost control is denial of service and rationing of care via ever increasing complex treatment approval systems, resulting in spiraling costs.” He then concludes:
A free-market system is shown to be the only reasonable method of reform that addresses the true underlying problems of the U.S. health care system and effectively lowers health care costs, allowing for universal insurance coverage for most everyone so any reasonable person — doctor, patient, Republican or Democrat — could support.
Not to be outdone, Kevin Tolliver, MD, asks In “A framework to understand universal health care:”
At its core, universal health care forces healthy people to pay for others’ medical care. Is this fair? Why should an active, healthy-eating, non-smoker pay for health care for an obese, sedentary diabetic who chain smokes all day?
In “Corporate games have ruined the health care system,” Osmund Agbo, MD, acknowledges that “When an insurance executive is making a seven-figure bonus, it’s very clear his loyalty lies somewhere else outside the interest of regular Americans struggling to pay an infinitely rising monthly premium.” He then informs us that “I am not a fan of socialist medicine. On the contrary, I am a firm believer in the free market enterprise system.”
Where does all of this irrationality and deranged thinking come from? Surely, the media has played a role. And yet we cannot discount the deleterious influence of the teaching hospital, which far more than medical school, profoundly shapes an impressionable trainee’s sense of right and wrong. Polluted and defiled by the pathogen of amorality, the fallen wallow in the plague wards of neoliberalism, banished from the world of compassion and rationality, and forever condemned to live out their days enveloped by a shroud of blindness.
Let us recall Pope’s haunting words in An Essay on Man: Epistle II:
Vice is a monster of so frightful mien,
As, to be hated, needs but to be seen;
Yet seen too oft, familiar with her face,
We first endure, then pity, then embrace.
Only by collectively acknowledging that health care cannot be sold as cars, kitchen appliances, and soap are sold; that it is the doctor’s sacred duty to treat all patients equally, regardless of their ability to pay; and that medical ethics can only flourish in a nonprofit socialized system, can we take this desperately needed step in reclaiming our humanity. For too long have American teaching hospitals been bastions for every form of knavery, perfidy, and skulduggery. These institutions must cast off their shackles of corporate thralldom, and join the fight to restore dignity and honor to American health care.