American health care has a moral problem

The health care system exploits people's sickness for profit. That’s wrong! We can fight the profiteering and win because moral force is on our side.

Early in my journalism career, I wrote about murder, drug deals and domestic violence. That’s wrongdoing our country rightly condemns.

For the past 16 years, my investigative reporting has exposed price gouging and profiteering in American health care. That’s wrongdoing our country has come to accept.

Before I became a journalist, I spent five years in full time ministry and earned a master’s degree in theology. My religious training raised a few eyebrows and even I had to wonder what role it would play in my work as a journalist. It turned out to be much more useful than I anticipated. Covering health care should have meant highlighting ways the industry lived up to its ideals of caring for patients. Instead, I uncovered a cesspool of deception and greed that felt like descending into Dante’s Inferno.

Politicians debate about our broken health care system as if it’s a mere policy issue. But at its core, the American health care system has a moral problem. And it doesn’t require going to seminary to see it. Sunday school will do. You’ve probably heard of The Golden Rule: “So in everything, do to others what you would have them do to you.” Those are the words of Jesus, recorded in the Bible, in Matthew 7. People from all different faith backgrounds and worldviews also believe that it’s wrong to be selfish and exploit others. Yet this foundation of human decency seems like it’s been lost on the business side of the American medical industry.

The companies running our health care industry have business plans based on taking advantage of people who are so desperate for healing that they will pay any price. This insidious immorality has metastasized to the point that our health care costs are about twice as much per citizen compared to other developed nations. And our health outcomes are worse. Costs go up every year and tens of millions of working Americans are uninsured or underinsured. About 1 in 5 Americans has medical debt in collections and medical costs are a common cause of bankruptcy. It’s routine for some people to go without the medication or treatment they need because they can’t afford it. We even have hospitals suing and garnishing the wages of patients who can’t afford their bills. This points to a deep moral problem that our policymakers and health care leaders have allowed to persist. “Whoever oppresses the poor shows contempt for their Maker,” Proverbs says. Our health care system needs to repent!

Let me be clear: I’m not saying it’s immoral for health care players to make any profit. Profit rewards excellence and incentivizes lifesaving innovation. But the business side of American health care is rooted in greedy and deceptive schemes that exploit people’s sickness. It’s using people’s suffering for profiteering. Greed is one of the Seven Deadly Sins!

Let’s consider some of the immoral behavior that’s been built into the American health care system. The federal government required hospitals to post their prices for common services, including the previously secret rates they have negotiated with each insurance carrier. The rule went into effect on the first day of 2021. But most hospitals have refused to comply. It’s wrong to violate the federal price transparency rule. And it’s deceptive when health care providers don’t share prices up front. This isn’t how it works when we buy groceries, or a car, or pick a cell phone service. So why would it be OK in health care?

Where we’ve been able to see prices, we have learned how some patients are required to pay more than others for the exact same services. I recently reviewed the bills of a woman whose insurance plan had negotiated a price for her and her health plan to pay $5,805 for an emergency room visit. But the prices her hospital posted on its website showed that other health plans had much lower negotiated prices for the same thing - $768 for one health plan and $230 for another. Even the cash price came in at a much lower price - $256! The hospital still came after her and her health plan for the full $5,805.

Patients covered by Medicare, the government’s insurance plan for people who are disabled or over age 65, typically pay some of the lowest prices. That’s because the federal government sets those rates. But working Americans covered by commercial insurance plans may pay two- to five-times the Medicare rates and more, at the same place, for the same services.

Patients covered by different commercial insurance carriers may also pay much more or less than each other. That’s because those commercial insurance prices are set by behind-the-scenes haggling and horse trading that’s more dependent on market share and branding than giving people a fair deal. It’s not right to require some patients to pay more than others for the exact same thing. The Bible condemns favoritism, calling it a sin. We would not accept some people paying more than others in a restaurant, and there’s no reason it makes sense for health care, either. 

How about those rising drug prices? The cost of insulin has been rising so fast it’s become totally unaffordable to many diabetics, requiring them to go without or ration it. A Congressional committee obtained 1.5 million pages of internal drug company documents and found, among other things, that insulin manufacturers aggressively raised prices in lockstep with each other and engaged in anticompetitive behavior. Meanwhile, diabetics were rationing insulin and going without it because of the unjustifiable prices.

“Drug companies have raised prices relentlessly for decades while manipulating the patent system and other laws to delay competition from lower-priced generics,” the committee found. “These companies have specifically targeted the U.S. market for higher prices, even while cutting prices in other countries, because weaknesses in our health care system have allowed them to get away with outrageous prices and anticompetitive conduct.”

That’s not morally acceptable – yet it’s standard practice for American health care.

I could go on and on. I’m continually astonished by what I find. Our health care system suffers from what sociologists call the normalization of deviance. We’ve come to accept what’s morally wrong as right. It wasn’t always this way. Historically, health care put the needs of patients before its own desire to make money.

I poured my 16 years of investigating health care – including more than a decade at ProPublica – into my new book, “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win.” The book is a how-to guide to help equip and empower consumers and employers to fight back. I’m loving how my book is helping people get a fair deal on health care, saving them tons of money. Now, thanks to the generous donations of many people to my crowdfunding campaign, I’m turning the book into a series of health literacy videos for consumers. It’s time to take action to protect ourselves because nobody is coming to our rescue.

Some people claim it’s just too difficult for patients to stand up for themselves. True, it can be difficult. But it can also be extremely easy. In one case it took me five minutes to look at my insurance company statement and see that an urgent care clinic had not even sent its claim to my insurance carrier before sending me a bill. I caught it before paying the bill, and it was corrected. I saved $250 in five minutes. In another case, my book helped one woman apply for financial assistance at a hospital and save more than $4,000. It took her about an hour. Yes, it can also be difficult to fight back. Sometimes it takes weeks of emails and phone calls to deal with these problems - and even then, there is no guarantee that the billing errors or other issues will get corrected.

It may feel overwhelming to try and take on these unfair and unjustified health care costs. But let’s not forget - we are not alone. High health care costs are like the COVID-19 pandemic - we’re all being afflicted. Now we need to treat the problem. You may feel like you’re David up against a health care Goliath. But there are about 180 million similar American “Davids” in the same position. We have power in numbers and can overwhelm the health care giants with our demands for fair treatment. Those who can fight these battles should take them on, for ourselves, and for those who are unable to stand up for themselves. When you stand up against this wrongdoing, you do it for the greater good.

Also, let’s get back to morality. I love the mission statement of my former employer, ProPublica, which says it uses the “moral force” of investigative reporting to bring about change. Yes! In a similar way, each individual employee, or consumer, or patient, has a tremendous amount of “moral force” when they stand up against the immoral behavior of the health care system. We tap into a deep source of influence for good when we appeal to integrity. We provoke the conscience of the industry leaders, many who are good people working in a corrupted system. Never underestimate the moral force of each person’s battle for what’s right.

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Victory Story: I loved getting a message from a reader telling me how last week’s newsletter helped her get an itemized medical bill. Yessss!!! That’s what this newsletter, my book and my health literacy videos are all about — EMPOWERMENT.

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