By Michael Cummins, Editor, Intellicurean, August 1, 2025

American healthcare wasn’t always synonymous with bankruptcy, bureaucracy, and corporate betrayal. In its formative years, before mergers and market forces reshaped the landscape, the United States relied on a patchwork of community hospitals, charitable clinics, and physician-run practices. The core mission, though unevenly fulfilled, was simply healing. Institutions often arose from religious benevolence or civic generosity, guided by mottos like “Caring for the Community” or “Service Above Self.” Medicine, while never entirely immune to power or prejudice, remained tethered to the idea that suffering shouldn’t be monetized. Doctors frequently knew their patients personally, treating entire families across generations, with decisions driven primarily by clinical judgment and the patient’s best interest, not by algorithms from third-party payers.

Indeed, in the 1950s, 60s, and 70s, independent physicians took pride in their ability to manage patient care holistically. They actively strove to keep patients out of emergency rooms and hospitals through diligent preventative care and timely office-based interventions. During this era, patients generally held their physicians in high esteem, readily accepting medical recommendations and taking personal responsibility for following through on advice, fostering a collaborative model of care. This foundational ethos, though romanticized in retrospect, represented a clear distinction from the profit-driven machine it would become.

But this premise was systematically dismantled—not through a single malicious act, but via incremental policies that progressively tilted the axis from service to sale. The Health Maintenance Organization (HMO) Act of 1973, for instance, championed by the Nixon administration with the stated aim of curbing spiraling costs, became a pivotal gateway for private interests. It incentivized the creation of managed care organizations, promising efficiency through competition and integrated services. Managed care was born, and with it, the quiet, insidious assumption that competition, a force lauded in other economic sectors, would somehow produce compassion in healthcare.

It was a false promise, a Trojan horse for commercialization. This shift led to a strained patient-physician relationship today, contrasting sharply with earlier decades. Modern interactions are often characterized by anxiety and distrust, with the “AI-enabled patient,” frequently misinformed by online data, questioning their doctor’s expertise and demanding expensive, potentially unnecessary treatments. “A little bit of knowledge is a dangerous thing. Drink deep, or taste not the Pierian spring,” as Alexander Pope observed in “An Essay on Criticism” in 1711. Worse still, many express an unwillingness to pay for these services, often accumulating uncollectible debt that shifts the financial burden elsewhere.

Profit Motive vs. Patient Care: The Ethical Abyss Deepens

Within this recoding of medicine, ethical imperatives have been warped into financial stratagems, creating an ethical abyss that compromises the very essence of patient care. In boardrooms far removed from the sickbed, executives, often without medical training, debate the cost-benefit ratios of compassion. The pursuit of “efficiency” and “value” in these settings often translates directly into cost-cutting measures that harm patient outcomes and demoralize medical professionals. The scope of this problem is vast: total U.S. healthcare spending exceeded $4.5 trillion in 2022, representing over 17% of the nation’s GDP, far higher than in any other developed country.

“American healthcare has been able to turn acute health and medical conditions into a monetizable chronic condition.” (The editor of Intellicurean)

Insurance companies—not medical professionals—routinely determine what qualifies as “essential” medical care. Their coverage decisions are often based on complex algorithms designed to minimize payouts and maximize profits, rather than clinical efficacy. Denials are issued algorithmically, often with minimal human review. For instance, a 2023 study by the Kaiser Family Foundation revealed that private insurers deny an average of 17% of in-network claims, translating to hundreds of millions of denials annually. These aren’t minor rejections; they often involve critical surgeries, life-saving medications, or extended therapies.

Appeals become Kafkaesque rituals of delay, requiring patients, often already sick and vulnerable, to navigate labyrinthine bureaucratic processes involving endless phone calls, mountains of paperwork, and protracted legal battles. For many patients, the options are cruelly binary: accept substandard or insufficient care, or descend into crippling medical debt by paying out-of-pocket for treatments deemed “non-essential” by a corporate entity. The burden of this system is vast: a 2023 KFF report found that medical debt in the U.S. totals over $140 billion, with millions of people owing more than $5,000.

Another significant burden on the system comes from patients requiring expensive treatments that, while medically necessary, drive up costs. Insurance companies may cover these treatments, but the cost is often passed on to other enrollees through increased premiums. This creates a cross-subsidization that raises the price of healthcare for everyone, even for the healthiest individuals, further fueling the cycle of rising costs. This challenge is further complicated by the haunting specter of an aging population. While spending in the last 12 months of life accounts for an estimated 8.5% to 13% of total US medical spending, for Medicare specifically, the number can be as high as 25-30% of total spending. A significant portion of this is concentrated in the last six months, with some research suggesting nearly 40% of all end-of-life costs are expended in the final month. These costs aren’t necessarily “wasteful,” as they reflect the intense care needed for individuals with multiple chronic conditions, but they represent a massive financial burden on a system already straining under corporate pressures.

“The concentration of medical spending in the final months of life is not just a statistical anomaly; it is the ultimate moral test of a system that has been engineered for profit, not for people.” (Dr. Samuel Chen, Director of Bioethics at the National Institute for Public Health)

The ethical abyss is further widened by a monumental public health crisis: the obesity epidemic. The Centers for Disease Control and Prevention (CDC) reports that over 40% of American adults are obese, a condition directly linked to an array of chronic, expensive, and life-shortening ailments. This isn’t just a lifestyle issue; it’s a systemic burden that strains the entire healthcare infrastructure. The economic fallout is staggering, with direct medical costs for obesity-related conditions estimated to be $173 billion annually (as of 2019 data), representing over 11% of U.S. medical expenditures.

“We’ve created a perverse market where the healthier a population gets, the less profitable the system becomes. The obesity epidemic is a perfect storm for this model: a source of endless, monetizable illness.” (Dr. Eleanor Vance, an epidemiologist at the Institute for Chronic Disease Studies)

While the healthcare industry monetizes these chronic conditions, a true public health-focused system would prioritize aggressive, well-funded preventative care, nutritional education, and community wellness programs. Instead, the current system is engineered to manage symptoms rather than address root causes, turning a public health emergency into a profitable, perpetual business model. This same dynamic applies to other major public health scourges, from alcohol and substance use disorders to the widespread consumption of junk food. The treatment for these issues—whether through long-term addiction programs, liver transplants, or bariatric surgery—generates immense revenue for hospitals, clinics, and pharmaceutical companies. The combined economic cost of alcohol and drug misuse is estimated to be over $740 billion annually, according to data from the National Institutes of Health.

The food and beverage industry, in turn, heavily lobbies against public health initiatives like soda taxes or clear nutritional labeling, ensuring that the source of the problem remains profitable. The cycle is self-sustaining: corporations profit from the products that cause illness, and then the healthcare system profits from treating the resulting chronic conditions. These delays aren’t accidents; they’re operational strategies designed to safeguard margins.

Efficiency in this ecosystem isn’t measured by patient recovery times or improved health metrics but by reduced payouts and increased administrative hurdles that deter claims. The longer a claim is delayed, the more likely a patient might give up, or their condition might worsen to the point where the original “essential” treatment is no longer viable, thereby absolving the insurer of payment. This creates a perverse incentive structure where the healthier a population is, and the less care they use, the more profitable the insurance company becomes, leading to a system fundamentally at odds with public well-being.

Hospitals, once symbols of community care, now operate under severe investor mandates, pressuring staff to increase patient throughput, shorten lengths of stay, and maximize billable services. Counseling, preventive care, and even the dignified, compassionate end-of-life discussions that are crucial to humane care are often recast as financial liabilities, as they don’t generate sufficient “revenue per minute.” Procedures are streamlined not for optimal medical necessity or patient comfort but for profitability and rapid turnover. This relentless drive for volume can compromise patient safety. The consequences are especially dire in rural communities, which often serve older, poorer populations with higher rates of chronic conditions.

Private equity acquisitions, in particular, often lead to closures, layoffs, and “consolidations” that leave entire regions underserved, forcing residents to travel vast distances for basic emergency or specialty care. According to data from the American Hospital Association, over 150 rural hospitals have closed since 2010, many after being acquired by private equity firms, which have invested more than $750 billion in healthcare since 2010 (according to PitchBook data), leaving millions of Americans in “healthcare deserts.”

“Private equity firms pile up massive debt on their investment targets and… bleed these enterprises with assorted fees and dividends for themselves.” (Laura Katz Olson, in Ethically Challenged: How Private Equity Firms Are Impacting American Health Care)

The metaphor is clinical: corporate entities are effectively hemorrhaging the very institutions they were meant to sustain, extracting capital while deteriorating services. Olson further details how this model often leads to reduced nurse-to-patient ratios, cuts in essential support staff, and delays in equipment maintenance, directly compromising patient safety and quality of care. This “financial engineering” transforms a vital public service into a mere asset to be stripped for parts.

Pharmaceutical companies sharpen the blade further. Drugs like insulin—costing mere dollars to produce (estimates place the manufacturing cost for a vial of insulin at around $2-$4)—are sold for hundreds, and sometimes thousands, of dollars per vial in the U.S. These exorbitant prices are shielded by a labyrinth of evergreening patents, aggressive lobbying, and strategic maneuvers to suppress generic competition. Epinephrine auto-injectors (EpiPens), indispensable and time-sensitive for severe allergic reactions, similarly became emblematic of this greed, with prices skyrocketing by over 400% in less than a decade, from around $100 in 2009 to over $600 by 2016. Monopoly pricing isn’t just unethical—it’s lethal, forcing patients to ration life-saving medication, often with fatal consequences.

“The U.S. pays significantly more for prescription drugs than other high-income countries, largely due to a lack of government negotiation power and weaker price regulations.” (A Commonwealth Fund analysis)

This absence of negotiation power allows pharmaceutical companies to dictate prices, viewing illnesses as guaranteed revenue streams. The global pharmaceutical market is a massive enterprise, with the U.S. alone accounting for over 40% of global drug spending, highlighting the industry’s immense financial power within the country.

Meanwhile, physicians battle burnout at rates previously unimaginable, a crisis that predates but was exacerbated by recent global health challenges. But the affliction isn’t just emotional; it’s systemic.

“The healthcare system contributes to physician suffering and provides recommendations for improving the culture of medicine.” (Dimitrios Tsatiris, in his 2025 book, Healthcare Is Killing Me: Burnout and Moral Injury in the Age of Corporate Medicine)

Tsatiris highlights how administrative burdens—such as endless electronic health record (EHR) documentation, pre-authorization requirements, and quality metrics that often feel detached from actual patient care—consume up to half of a physician’s workday. The culture, as it stands, is one of metrics, audits, and profound moral dissonance, where doctors feel increasingly alienated from their core mission of healing.

This moral dissonance is compounded by the ever-present threat of malpractice litigation. Today’s physician is often criticized for sending too many patients to the emergency room, perceived as an unnecessary cost driver. However, the alternative is fraught with peril: in the event they don’t send a patient to the ER and a severe outcome occurs, they can be sued and held personally liable, driving up malpractice insurance premiums and fostering a culture of defensive medicine. This creates a perverse incentive to err on the side of caution—and higher costs—even when clinical judgment might suggest a less aggressive, or more localized, approach.

Doctors are punished for caring too much, for spending extra minutes with a distressed patient when those minutes aren’t billable. Nurses are punished for caring too long, forced to oversee overwhelming patient loads due to understaffing. The clinical encounter, once sacred and unhurried, has been disfigured into a race against time and billing software, reducing human interaction to a series of data entries. This systemic pressure ultimately compromises the quality of care and the well-being of those dedicated to providing it.

The Missing Half of the Equation: Patient Accountability

The critique of corporate influence, however, cannot absolve the patient of their role in this crisis. A sustainable and ethical healthcare system requires a reciprocal relationship between providers and recipients of care. While the system is engineered to profit from illness, the choices of individuals can either fuel this machine or actively work against it. This introduces a critical and often uncomfortable question: where does personal responsibility fit into a system designed to treat, not prevent, disease?

The most significant financial and physical burdens on the American healthcare system are a direct result of preventable chronic conditions. The obesity epidemic, for instance, is not just a statistical anomaly; it is a profound failure of both a profit-driven food industry and a culture that has de-emphasized personal well-being. A system that must manage the downstream effects of sedentary lifestyles, poor nutrition, and substance abuse is inherently overstretched. While the system profits from treating these conditions, the individual’s choices contribute to the collective cost burden for everyone through higher premiums and taxes. A true reformation of healthcare must therefore be a cultural one, where individuals are empowered and incentivized to engage in self-care as a civic duty.

Preventative care is often framed as an action taken in a doctor’s office—a check-up, a screening, a vaccination. But the most impactful preventative care happens outside of the clinic. It is in the daily choices of diet, exercise, stress management, and sleep. A reformed system could and should champion this type of self-care. It would actively promote nutritional education and community wellness programs, recognizing that these are not “extras” but essential, cost-saving interventions.

“Patients bear a moral and practical responsibility for their own health through lifestyle choices. By engaging in preventative care and healthy living, they not only improve their personal well-being but also act as a crucial partner in the stewardship of finite healthcare resources. A just system of care must therefore recognize and support this partnership by making treatment accessible through means-based financial responsibility, ensuring that necessary care is never a luxury, but rather a right earned through shared commitment to health.” (From reviews of publications like the AMA Journal of Ethics, as cited by Intellicurean)

This approach would reintroduce a sense of shared responsibility, where patients are not just passive consumers but active participants in their own health journey and the health of the community. This is not about blaming the sick; it’s about building a sustainable and equitable system where every member plays a part.

A System of Contradictions: Advanced Technology, Primitive Access

American healthcare boasts unparalleled technological triumphs: robotic surgeries, groundbreaking gene therapies, AI-driven diagnostics, and personalized medicine that seemed like science fiction just a decade ago. And yet, for all its dazzling innovation, it remains the most inaccessible system among wealthy nations. This isn’t a paradox—it’s a stark, brutal contradiction rooted in profiteering, a testament to a system that prioritizes cutting-edge procedures for a few over basic access for all.

Millions remain uninsured. Even with the Affordable Care Act (ACA), approximately 26 million Americans remained uninsured in 2023, representing 8% of the population, according to the U.S. Census Bureau. Millions more endure insurance plans so riddled with exclusions, high deductibles, and narrow networks that coverage is, at best, illusory—often referred to as “junk plans.” For these individuals, a single emergency room visit can summon financial ruin.

The Commonwealth Fund’s 2024 report, “The Burden of Health Care Costs on U.S. Families,” found that nearly half of U.S. adults (49%) reported difficulty affording healthcare costs in the past year, with 29% saying they skipped or delayed care due to cost. This isn’t the failure of medical science or individual responsibility; it’s the direct consequence of policy engineered for corporate profit, where profit margins are prioritized over public health and economic stability.

“Patients being saddled with high bills, less accessible health care.” (Center for American Progress, in its September 2024 report “5 Ways Project 2025 Puts Profits Over Patients”)

The statistics are blunt, but the human toll is brutal—families delaying crucial preventative screenings, rationing life-sustaining medications, and foregoing necessary doctor visits. This forced delay or avoidance of care exacerbates chronic conditions, leads to more severe acute episodes, and ultimately drives up overall healthcare costs as untreated conditions become emergencies.

The marketplace offers these “junk” plans—low-premium, high-deductible insurance packages that cover little and confuse much. They are often marketed aggressively, sold with patriotic packaging and exploiting regulatory loopholes, but they deliver little beyond financial instability and false security. These plans disproportionately affect lower-income individuals and communities of color, who are often steered towards them as their only “affordable” option.

For instance, Black and Hispanic adults are significantly more likely to report medical debt than their White counterparts, even when insured. A 2022 study published in JAMA Network Open found that Black adults were 50% more likely to hold medical debt than White adults, and Hispanic adults were 30% more likely. This disparity reflects deeper systemic inequities, where a profit-driven system exacerbates existing racial and economic injustices.

Core public health services—mental health, maternal care, chronic disease management, and preventative care—receive paltry funding and are consistently difficult to access unless they are highly monetizable. The economic logic is ruthless: if a service doesn’t generate significant revenue, it doesn’t merit substantial corporate investment. This creates a fragmented system where crisis intervention is prioritized over holistic well-being, leading to a mental health crisis, rising maternal mortality rates (especially among Black women, who are 2.6 times more likely to die from pregnancy-related causes than White women), and uncontrolled epidemics of chronic diseases like diabetes and heart disease.

Even public institutions like the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), once considered bastions of scientific authority and public trust, have seen their credibility questioned. The decline isn’t a function of conspiracy or scientific incompetence—it’s the direct consequence of their proximity to, and perceived capture by, corporate interests. Pharmaceutical lobbyists heavily influence drug approval timelines and post-market surveillance. Political appointees, often with ties to industry, dilute public health messaging or prioritize economic considerations over scientific consensus. The suspicion is earned, and it undermines the very infrastructure of collective health protection.

“Forced to devote substantial time and resources to clear insurer-imposed administrative hurdles, physicians feel powerless and wholly unable to provide patients with timely access to evidence-based care.” (Dr. Jack Resneck Jr., MD, former President of the American Medical Association (AMA))

The physician’s lament crystallizes the crisis. This reflects a profound loss of professional autonomy and moral injury among those dedicated to healing. Medicine is no longer a nuanced conversation between expert and patient—it is a transaction administered by portal, by code, by pre-authorization, stripping away the human connection that is vital to true care.

The Rising Resistance: Reclaiming the Soul of Medicine

Yet even amid this profound disillusionment and systemic capture, resistance blooms. Physicians, nurses, activists, policy architects, and millions of ordinary Americans have begun to reclaim healthcare’s moral foundation. Their campaign isn’t merely legislative or economic—it’s existential, a fight for the very soul of the nation’s commitment to its people.

Grassroots organizations like Physicians for a National Health Program (PNHP) and Public Citizen are at the forefront, vigorously arguing for a publicly funded, universally accessible system. Their premise isn’t utopian but ethical and pragmatic: health is a fundamental human right, not a commodity to be bought or a reward for economic success. They point out the immense administrative waste inherent in the current multi-payer system, where billions are spent on billing, marketing, and claims processing rather than direct patient care.

A 2020 study published in the Annals of Internal Medicine estimated that U.S. administrative healthcare costs amounted to $812 billion in 2017, representing 34% of total healthcare expenditures, significantly higher than in comparable countries with universal systems. This staggering figure represents money siphoned away from nurses’ salaries, vital equipment, and preventative programs, disappearing into the bureaucratic machinery of profit.

Nursing unions have emerged as fierce and indispensable advocates for patient safety, pushing for legally mandated staffing ratios, equitable compensation, and genuinely patient-centered care. They understand that burnout isn’t an individual failure but an institutional betrayal, a direct result of corporate decisions to cut corners and maximize profits by overloading their frontline workers. Their strikes and advocacy efforts highlight the direct link between safe staffing and patient outcomes, forcing a public conversation about the true cost of “efficiency.”

“A unified system run by health care professionals—not politicians or commercial insurers—that offers universal coverage and access.” (Gilead I. Lancaster, in his 2023 book, Building a Unified American Health Care System: A Blueprint for Comprehensive Reform)

Lancaster’s blueprint provides a detailed roadmap for a system that puts medical expertise and public health at its core, stripping away the layers of financial intermediation that currently obfuscate and obstruct care.

The Medicare for All proposal, while polarizing in mainstream political discourse, continues to gain significant traction among younger voters, disillusioned professionals, and those who have personally suffered under the current system. It promises to erase premiums, eliminate deductibles and co-pays, and expand comprehensive access to all medically necessary services for every American. Predictably, it faces ferocious and well-funded opposition from the entrenched healthcare industry—an industry that spends staggering sums annually on lobbying. According to OpenSecrets, the healthcare sector (including pharmaceuticals, health services, and insurance) spent over $675 million on federal lobbying in 2024 alone, deploying an army of lobbyists to protect their vested interests and sow doubt about single-payer alternatives.

Terms like “government takeover” and “loss of choice” pollute the public discourse, weaponized by industry-funded campaigns. But what “choice” do most Americans actually possess? The “choice” between financial ruin from an unexpected illness or delaying life-saving care isn’t liberty—it’s coercion masked as autonomy, a perverse redefinition of freedom. For the millions who face medical debt, unaffordable premiums, or simply lack access to specialists, “choice” is a cruel joke.

The resistance is deeply philosophical. Reformers seek to restore medicine as a vocation—an act of trust, empathy, and collective responsibility—rather than merely a transaction. They reference global models: Canada’s single-payer system, the UK’s National Health Service, France’s universal coverage, Germany’s multi-payer but non-profit-driven system. These systems consistently offer better health outcomes, lower per-capita costs, and vastly fewer financial surprises for their citizens. For instance, the U.S. spends roughly $13,490 per person on healthcare annually, nearly double the average of other high-income countries, which spend an average of $6,800 per person (according to the OECD). This stark contrast provides irrefutable evidence that the U.S. system’s astronomical cost isn’t buying better health, but rather fueling corporate profits.

The evidence is not in dispute. The question, increasingly, is whether Americans will finally demand a different social contract, one that prioritizes health and human dignity over corporate wealth.

The Path Forward: A New Social Contract

The corporate contamination of American healthcare isn’t an organic evolution; it’s engineered—through decades of deliberate policy decisions, regulatory capture, and a dominant ideology that privileged profit over people. This system was built, brick by brick, by powerful interests who saw an opportunity for immense wealth in the vulnerabilities of the sick. And systems that are built can, with collective will and sustained effort, be dismantled and rebuilt.

But dismantling isn’t demolition; it’s reconstruction—brick by ethical brick. It requires a profound reimagining of what healthcare is meant to be in a just society. Healthcare must cease to be a battleground between capital and care. It must become a sanctuary—a fundamental social commitment embedded in the national psyche, recognized as a public good, much like education or clean water. This commitment necessitates a radical reorientation of values within the system itself.

This will require bold, transformative legislation: a fundamental redesign of funding models, payment systems, and institutional accountability. This includes moving towards a single-payer financing system, robust price controls on pharmaceuticals, stringent regulations on insurance companies, and a re-evaluation of private equity’s role in essential services.

As editor of Intellicurean, I propose an innovative approach: establishing new types of “healthcare cash accounts,” specifically designated and utilizable only for approved sources of preventative care. These accounts could be funded directly by a combination of tax credits from filed tax returns and a tax on “for-profit” medical system owners and operators, health insurance companies, pharmaceutical companies, publicly held food companies, and a .05% tax on billionaires and other sources.

These accounts could be administered and accounted for by approved banks or fiduciary entities, ensuring transparency and appropriate use of funds. Oversight could be further provided by an independent review board composed of diverse stakeholders, including doctors, clinicians, and patient advocates, ensuring funds are directed towards evidence-based wellness initiatives rather than profit centers.

As a concrete commitment to widespread preventative health, all approved accountholders, particularly those identified with common deficiencies, could also be provided with essential, evidence-backed healthy supplements such as Vitamin D, and where appropriate, a combination of Folic Acid and Vitamin B-12, free of charge. This initiative recognizes the low cost and profound impact of these foundational nutrients on overall well-being, neurological health, and disease prevention, demonstrating a system that truly invests in keeping people healthy rather than simply treating illness.

Americans must shed the pervasive consumerist lens through which healthcare is currently viewed. Health isn’t merely a product or a service to be purchased; it’s a shared inheritance, intrinsically linked to the air we breathe, the communities we inhabit, and the equity we extend to one another. We must affirm that our individual well-being is inextricably tethered to our neighbor’s—that human dignity isn’t distributable by income bracket or insurance plan, but is inherent to every person. This means fostering a culture of collective responsibility, where preventative care for all is understood as a collective investment, and illness anywhere is recognized as a concern for everyone.

The path forward isn’t utopian; it’s political, and above all, moral. It demands courage from policymakers to resist powerful lobbies and courage from citizens to demand a system that truly serves them. Incrementalism, in the face of such profound systemic failure, has become inertia, merely postponing the inevitable reckoning. To wait is to watch the suffering deepen, the medical debt mount, and the ethical abyss widen. To act is to restore the sacred covenant between healer and healed.

The final question is not one of abstract spirituality, but of political will. The American healthcare system, with its unparalleled resources and cutting-edge innovations, has been deliberately engineered to serve corporate interests over public health. Reclaiming it will require a sustained, collective effort to dismantle the engine of profiteering and build a new social contract—one that recognizes health as a fundamental right, not a commodity.

This is a battle that will define the character of our society: whether we choose to continue to subsidize greed or to finally invest in a future where compassion and care are the true measures of our progress.

THIS ESSAY WAS WRITTEN AND EDITED BY MICHAEL CUMMINS UTILIZING AI