When you are in business the goal is to make money. The interpersonal aspects of that continuum range from "The business of business is business" to "The customer is always right." An op-ed piece in the New York Times introduces us to another approach to making money and that is with the client or at the expense of the client. A Wall Street insider gives us a rare glimpse into one of the largest investment banking firms and how their culture shifted over the past two decades to focus on profiting from their clients rather than profiting with them. That same firm was already accused in 2010 of selling its clients mortgage-backed securities and betting against them. A professor of corporate governance from the University of Delaware commented about how the structure of these companies changed as they became public and started to look for as many clients as possible.
For the same period of time the change in corporate governance of healthcare corporations has also gone through a revolution. There has been a shift from medical guidance to business guidance. Many if not most clinics and hospitals have changed their corporate governance so that doctors are subordinate to businessmen. The changes are often very subtle but the overall process has a focus on making money rather than optimal patient care. There is plenty of window dressing along the way that is frequently sold as quality but the bottom line is that any physician or patient will generally sustain some kind of significant cost dealing with a healthcare corporation or pharmacy benefit manager.
When physicians are taken out of the loop, the business of medicine is no longer treating illness and alleviating suffering but it becomes making money and the only way that happens is to profit from patients and get as much free work as possible from doctors.
George Dawson, MD
Nelson D. Schwartz . A Public Exit From Goldman Sachs Hits at a Wounded Wall Street. New York Times March 14, 2012.
Greg Smith. Why I Am Leaving Goldman Sachs. New York Times March 14, 2012.