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,” 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” 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” 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 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 complex” 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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