IHI Forum: Don Berwick calls out greed, rallies industry to protest monetization of healthcare

In an impassioned speech at the Institute for Healthcare Improvement forum last week, president emeritus and senior fellow Donald Berwick, M.D., rallied listeners to call out the greed in healthcare. 

He questioned why in a country as wealthy as the U.S., where a fifth of GDP is spent on care, there is so much distress, pressure, pain and fear in healthcare. “You cannot solve a problem that you cannot name,” Berwick said. “The pursuit of wealth now dominates the political economy of American healthcare.” 

Berwick, a former administrator of the Centers for Medicare & Medicaid Services, criticized Medicare Advantage, calling it “the movement of public dollars through private insurance companies.” He criticized the program’s motives, saying that instead of harnessing payers’ skills to better manage care, “today Medicare Advantage is the primary engine of profit for many major U.S. insurance companies.” It will cost the U.S. an extra $600 billion more than traditional Medicare. In return, hospitals and health systems have to “play that coding game” that payers use to make a profit. 

Berwick referred to the 2020 Bloomberg list of the highest-paid executives. Three of them were from Oak Street Health, which plays heavily in Medicare Advantage, he noted. At the same time, consolidation runs rampant in healthcare. “There are few conclusions in empirical and economic research that are as widely agreed upon as this: Mergers almost never yield the cost savings that the parties promise,” Berwick said. Instead, they concentrate market power and raise costs. 

With millions of Americans in medical debt, “more and more of that toll is coming out of the pockets of people,” Berwick said. “A system of greed in healthcare shapes generational poverty.” While price hikes are justified with innovation, competition and risk-taking, it is really exploitation, gains of arbitrage and a lack of discipline, he added. 

“The American healthcare industry is, I strongly suspect, today the largest machine for the regressive transfer of wealth from the poorer to the richer in the history of our nation,” Berwick said. 

Greed and the monetization of healthcare distract from healthcare’s shared mission of equity and healing. Healthcare professionals must protest greed with the public and with lawmakers, he said. It is not about attacking individuals, but systemic support for these behaviors must end. Berwick called for the reform of patent laws, changes to coding rules and the strengthening of antitrust policy. 

“Health is a public good and needs to be pursued as a public good,” he concluded.