Introduction In recent developments within the healthcare sector, a series of reports have highlighted pressing issues surrounding profit in medicine. The challenges raised by changes in healthcare policy, the role of insurance companies, and technological advancements in surgical practices present a complicated landscape. This overview explores the implications of these changes, accompanied by real-life examples that underscore the human element in healthcare.
Part the First: Profit in Medicine. A heart-wrenching report from STAT reveals that HCA warns of decreased future profits as more patients become uninsured, a consequence of the expiration of ObamaCare subsidies:
The country’s largest hospital chain has lowered its profit outlook for 2026 after treating unexpectedly high numbers of uninsured patients in the second quarter.
HCA Healthcare has stated that many of these uninsured individuals dropped their Affordable Care Act plans following the reduction in enhanced subsidies, indicating early signs of the fallout from the expiration of these premium tax credits in January.
Overall, HCA anticipates that the surge in uninsured patients due to the subsidy conclusion will reduce its income by between $1 billion and $1.2 billion this year, an increase from its previous estimate of $600 million to $900 million.
Despite this setback, HCA still expects to achieve approximately $15.8 billion in adjusted earnings before interest, taxes, depreciation, and amortization (EBITDA) at the midpoint, a decrease from the $16 billion projected in January. Following the early morning announcement, the company’s stock price dipped nearly 7%.
“We are confident in our ability to navigate this dynamic environment and remain focused on enhancing patient care while executing our strategic plan to digitize and expand our healthcare networks,” stated HCA CEO Sam Hazen.
While medical care is undoubtedly not free, there are those of us who find it surprising to witness the current state of affairs. Previously, individuals with health insurance faced few concerns, and those without still accessed necessary care. A colleague in the medical field noted that, in the past, doctors were compensated 90% of the time, and when they weren’t, it was manageable. Local public hospitals, overseen by civic leaders, often did not pursue unpaid bills from patients unable to afford them, understanding their plight on a personal level.
A recent ranking of 105 healthcare systems by annual revenue illustrates this changing landscape. My family is presently navigating one of the top ten systems regarding an essential yet straightforward surgical procedure that will cost the employer health plan around $100,000, depending on its complexity. Our financial contribution is significant to us, yet it seems to be increasing. Fortunately, we can manage our share. However, the situation would have been very different for someone working in the bursar’s office, as our out-of-pocket expense could represent a month’s salary or more. Many may recall my previous quotes from Aneurin Bevan, who organized the UK’s National Health Service shortly after World War II: “The field in which the claims of individual commercialism come into most immediate conflict with reputable notions of social values is that of health.”
There’s little more to say here, except to reflect on Herb Stein: If something cannot continue forever, it will eventually stop. Stein served during the Nixon Administration, a time that surprisingly included a number of commendable individuals. The pertinent question now is what happens next: will we see universal healthcare (public, with no immediate costs) or a deeper entrenchment of Lambert’s Laws of Neoliberalism: (1) Markets! (2) Go perish!
Part the Second: Don’t Mess with Chris Deacon. Turning to the realm of health insurance, This whistleblower took on a health insurance giant and a political machine. She’s not stopping there:
It should have been a victorious moment for Chris Deacon.
Last November, Horizon Blue Cross Blue Shield, the insurance powerhouse managing health benefits for 750,000 New Jersey state workers and retirees, agreed to pay $100 million to settle allegations of knowingly overpaying hospitals and doctors to obtain their state contract fraudulently.
At the press conference, then-New Jersey Attorney General Matthew Platkin celebrated this as a “historic” action. “Today’s settlement delivers a clear message: Horizon and the entire insurance industry cannot exploit the state,” Platkin declared, flanked by his staff. “They cannot compel us to pay more for healthcare illegally.”
Deacon played a pivotal role in uncovering Horizon’s alleged misconduct while overseeing New Jersey’s health plan.
Yet, instead of sharing in the triumph, she experienced mixed emotions as she observed the press conference from her home office. While she felt a sense of justice, she also experienced disgust and sadness that officials overlooked her contributions while downplaying their own accountability.
“You try to do the right thing, and this is the outcome,” Deacon lamented. “I have come to terms with it, but being omitted even as a mere footnote felt like their final ‘screw you’ to me.”
Reports suggest that the settlement hinged on Chris Deacon being excluded from its acknowledgment. Now working as an independent lawyer and consultant, she has garnered attention:
People in high positions across government and the private sector are taking note. Deacon has testified in front of Congress twice in the past year and has advised leaders on state health care legislation, encouraging more employers to scrutinize their insurance contracts.
“I’m a huge fan,” Mark Cuban remarked to STAT via email. The billionaire entrepreneur and former “Shark Tank” investor has become an outspoken critic of health insurance providers and pharmacy benefit managers, urging his 8.4 million LinkedIn followers to pay attention to Deacon’s insights. “She is fearless, focused, and is making a significant impact.”
Deacon continues her mission, tackling one health system at a time.
Part the Third: The Future of Robotic Surgery. Advances in technology have propelled modern medicine forward: moving from X-rays and MRIs to minimally invasive surgical techniques. Procedures such as cholecystectomy (gallbladder removal) are now often outpatient with recovery times measured in days, a stark contrast to their previously invasive forms that resulted in significant scarring and extended recovery periods. This shift is seen in other procedures like appendectomies, where once-significant scars are now nearly imperceptible.
Aurélien Guéroult has articulated the profound changes in surgery in his piece Surgery and The Limits of The Robotic Ideal:
Clinical medicine is one of the most fundamentally human professions. Surgeons must first comprehend and then manipulate the intricacies of human biology. Will medicine and surgery be the final frontier for complete robotic automation?
Robotic surgery, or more accurately, robot-assisted surgery, has become a common practice over the past two decades around the globe, including within the UK’s National Health Service (NHS). In the 1990s, robotic scientists developed machines capable of interpreting continuous operator input into real-time movements, leading to the creation of surgical robots that accurately replicate a surgeon’s hand movements. The US-developed da Vinci surgical system, which received FDA approval in 2000, is a leading example, although similar technologies from China and the EU are now available. These robots, however, are not autonomous; the operating surgeon remains in complete control of the robotic arms, which are managed via a console.
The use of surgical robots is primarily limited to specific types of operations. Throughout the latter half of the 20th century, all surgical specialties have worked to make procedures less invasive. This has resulted in the development of video-assisted ‘keyhole’ surgery—a groundbreaking approach that has largely replaced traditional ‘open’ techniques. Many specialties have adopted these keyhole techniques, largely driven by patient preferences and quicker recovery times. Internal camera video systems are now commonplace in surgical arenas across various medical fields such as abdominal, thoracic, gynecological, and even cardiovascular surgeries.
Dr. Guéroult concludes that “Robot-assisted surgery is increasingly integrated into routine practice. Yet the aspiration for machines to operate independently underestimates the practical judgment that years of experience bestows upon a surgeon.” He is right. The precision of robotic surgery, operated by skilled surgeons, represents a significant advancement. However, excessive reliance on technology may echo the flawed engineering models applied to biology in clinical settings. I recently conversed with Dr. B, an engineering graduate who expressed fascination with ChatGPT’s capacity to assess lab reports. The critical flaw is that these reports cannot replace the real-time interaction with a patient. The information generated by ChatGPT lacks the depth of patient understanding and context crucial for healthcare professionals. This distinction appears difficult for some to grasp, as evidenced by the fervor surrounding emerging technologies
A common adage in medical circles states: “The surgeon knows nothing and does everything, while the internist knows everything and does nothing.” While not entirely accurate, it highlights an important point: all art and science require extensive knowledge, intuition cultivated from experience, and suitable techniques for each individual situation. There can be no shortcuts. Information produced by systems like ChatGPT may seem convincing but does not equate to true knowledge. Without intuition and an understanding of what constitutes ‘normal’ or ‘abnormal,’ surgical robots, despite their sophisticated technology, may remain hazardous in clinical environments. Presently, the notion that AI could entirely take over human roles in these disciplines is misguided. The concern now is whether decision-makers will recognize this before it becomes too late.
Part the Fourth: The War on USAID and Its Consequences. The United States Agency for International Development (USAID), established during the early years of the Kennedy Administration, has played an essential role in projecting American influence globally. Its origins may come with undertones of elitism, yet it has accomplished considerable humanitarian efforts alongside its political narratives. Though concerns about “waste, fraud, and abuse” within its operations arise, it is essential to clarify that such shortcomings do not encapsulate the agency’s purpose. Disturbingly, recent critiques have focused on USAID and the National Science Foundation while bypassing more significant concerns at the Pentagon.
In a conversation with The New Yorker, Atul Gawande, former administrator at U.S.A.I.D. during the Trump Administration, discussed the impact of policies that have dismantled the agency. Citing Richard Rhodes’ insights on mortality caused by neglect, Gawande articulated the human cost associated with reducing funding for USAID, estimating about 700,000 deaths—a figure that could escalate into millions. He emphasized that such policies undermine American influence while inflicting immeasurable suffering across regions.
Elon Musk, who disputes these death toll estimates, is misguided. It’s crucial to consider how USAID could have identified early warning signs for crises, such as the recent Ebola outbreak in Central Africa.
What, me worry? Alfred E. Neuman, apparently immune to consequence.
Part the Fifth: The Secretary of War and Testosterone. Meanwhile, current defense strategies propose testing military personnel under 30 for low testosterone levels. A move criticized as absurd yet fitting the prevailing priorities of militarization. Secretary Hegseth champions these tests, asserting that male soldiers require “normal” testosterone levels to perform effectively, a claim equally valid for both genders. Questions arise whether this tactic reflects broader issues regarding equity in military promotion practices amidst gender disparities.
Perhaps a more fitting strategy would involve addressing root causes behind militarization versus instead lumping soldiers into hormone ranking systems. By refocusing away from unfettered militarism toward meaningful societal progress, we could strive to build a nation that truly reflects our highest ideals.
Thank you for reading! Your comments, critiques, and witty insights are welcome. I hope you enjoyed Bastille Day earlier this week: Liberté, Égalité, Fraternité. Until next week!
