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FOR-PROFIT MEDICINE IS RUINING MASSACHUSETTS HEALTH CARE  
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John E. McDonough
July 29, 2024
CommonWealth Beacon
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_ Steward, CVS, and United Health all have one thing in common _

, commonwealthbeacon.org

 

LIKE A SHRINKING number of you, I still get _The Boston Globe_ home
delivered every morning by a Haitian delivery guy from Dorchester.  I
know, getting it online is cheaper, easier, and environmentally
cleaner, and my kids still tease about it. Part of it for me is
sentimental—growing up in Waltham, I home delivered the afternoon
_Globe_ six days a week between ages 7-14. My wife still appreciates
the real paper. And every so often, I miss something important by not
seeing the printed edition. That happened this past Sunday.

Three articles dominated the front page. 

“Steward asks for earlier closures
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by Aaron Pressman et al, reported that Steward Health Care wants to
close Nashoba Valley Medical Center in Ayer and Carney Hospital in
Dorchester on August 31, about three months earlier than Massachusetts
Department of Public Health regulations require.

 

“Drugstore Deserts
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by Diti Kohli et al detailed how local “pharmacies are disappearing
at a rapid pace in poorer communities, making it harder for already
vulnerable people to get needed medications.” It’s happening in
low-income neighborhoods in Roxbury, East Boston, and Dorchester, as
well as in rural underserved communities across the state and the
nation.

“An assembly line of medicine where UnitedHealth can maximize its
profits
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by STAT’s Bob Herman et al describes how United, through its medical
practice division called Optum, has bought up physician networks all
over the nation, now fully ten percent of all US doctors, in pursuit
of mountainous profits. Their path involves squeezing docs and nurses
to see as many patients as possible without regard to patient need,
and diminishing access for patients. 

What ties these three front-page stories together?  They all involve
the growing dominance of rapacious for-profit medical care across the
nation and, yes, in Massachusetts. While much of Massachusetts’
medical care system remains resolutely non-profit, the signs of
for-profit encroachment are slow, silent, and everywhere. 

United/Optum made it entry into Massachusetts in 2018 by purchasing
the Reliant Medical Group in the Worcester region. In 2022, they
purchased Atrius Health (formerly Harvard Vanguard Medical Associates
and before that the Harvard Community Health Plan) with its 700
physicians for $236 million. Both purchases required approval by
then-Attorney General Maura Healey, getting green-lighted in each case
with support from their employed physicians.

The former Catholic “Caritas Christi” hospital system became
Steward Health Care, a for-profit entity bought by private equity
giant Cerberus (the Greek “hound of Hades”) in 2010. Then-Attorney
General Martha Coakley approved the deal with support from physicians
and workers and without any viable alternative. After state oversight
ended in 2015, Steward sold its real estate, buildings, and land to a
real estate investment trust (REIT) to pay off Cerberus, enrich its
boss Ralph de la Torre, and saddle its hospitals with rent obligations
they never had to endure before, setting the stage for today’s
collapse.

As a Boston state rep in the 1980s and 1990s, I saw local pharmacies
in Egleston and Roslindale Squares and on Centre Street in Jamaica
Plain throw in the towel and close their doors in the face of
unbeatable competition from CVS and Walgreens who are now ditching
many of their outposts and commitments. These days, CVS makes most of
its profits from its so-called Pharmacy Benefit Management firm, CVS
Caremark, which the New York Times
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documented in June uses its market power to drive independent
competitors out of business.    

In case you wonder, in 2023 UnitedHealth Group’s CEO, Andrew Witty,
received $23.3 million in compensation while his firm saw $22.4
billion in profits.  CVS Health’s CEO, Karen Lynch, got $21.6
million while her firm gained $8.3 billion in profits.  Steward’s
Chairman and CEO, de la Torre, made $5.2 million in pay. Stewards’
profits were…that’s another story!

Though experts disagree on the extent to which profits to shareholders
must be the only purpose of the stock-owned company, there’s no
denying that most for-profit CEOs see it that way. They look in the
mirror every morning and wonder: “what can I do today to increase
profits to my shareholders?” As they think that, they also think
about themselves because 80 percent, on average, of CEO compensation
is stock options for them. And because of how these benefits are
counted, their actual returns are far, far greater. 

I recall in the 1980s when the nation and Massachusetts first
seriously discussed the merits and demerits of for-profit medicine. In
1980, Dr. Arnold Relman, the late editor of the _New England Journal
of Medicine_, warned us of the new and growing “medical industrial
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that puts the interests of stockholders before the well-being of
patients. It’s here and it continues to grow.

The Massachusetts Senate and House are now considering legislation to
implement reforms to the Commonwealth’s health care system. While
many of these provisions are important and deserve far more attention
than anyone is paying, we also need a new “statement of purpose”
for our medical care system. For-profit ownership of medical care
delivery should be discouraged and prevented from further expansion as
a matter of state policy. We need to recapture our medical system’s
heart and soul and defend it from avaricious assault by corporate
America before it’s lost for good.

_John McDonough is professor of public health practice at the Harvard
T.H. Chan School of Public Health._

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CC BY-ND 4.0 Creative Commons license
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* For Profit Medicine; For Profit Hospitals; Stewart Health; CVS
Health; United Health;
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