What lies behind us or what lies before us are small matters when compared to what lies inside us.Ralph Waldo Emerson

Health Care and the Profit Motive

I am struck by a recent piece by NYT Economic Scene Columnist Eduardo Porter in which he raised the issue of “ how much should we rely on the private sector to satisfy broad social needs?” It’s a profound question, and one at the core of our political divisions. If we can make use of it, we might be in a better position to resolve many of our current issues, in health care, in education or in the delivery of public services. The piece is titled “Health Care and Profits, a Poor Mix” and he cites studies and cases where non-profit nursing homes and hospitals converted to be for-profit institutions. Patient care declined and in some cases increased mortality, apparently influenced by lower staffing levels. According to Porter, the U.S. relies on the private sector to deliver essential public services far more than other industrial nations. Pensions and bail bondsmen are examples. It stems, he says from a “more narrow understanding of our collective responsibility to provide social goods.” He goes on to discuss that our trust in private enterprise may be “undeserved” since the track record evidence does not support it, and he then raises the issue of how the profit motive, especially in health care, interferes with the quality and delivery of those services. It’s an argument that merits far more attention than we are inclined to give it.