Healthcare at a Crossroads: Balancing Profit, Access, and Equity
By Laurence T. Gayao, MD, FAAFP, BCEM
As an emergency room physician for several decades, I didn’t have much firsthand exposure to the business side of medicine. One of the aspects I loved most about emergency medicine is that every patient is treated equally, regardless of financial status, as mandated by U.S. law. Under the Emergency Medical Treatment and Labor Act (EMTALA), we are required to provide care to all, and as physicians, we never know—and are not supposed to ask—who has insurance and who does not.
When I reviewed summaries of my patient cases, I noticed something striking: only about 30% of my patients paid for the services I provided. Yet, this never influenced the quality of care delivered. For me, medicine was purely about saving lives, not balancing ledgers.
It wasn’t until I became a patient myself that I realized the staggering cost of healthcare in the United States. Following a quadruple coronary artery bypass graft (CABG), a subsequent hospitalization, and two other surgeries, I received a summary of services rendered. Had it not been for Medicare and supplemental insurance, the bills would have left me financially devastated.
This personal experience led me to reflect on a critical question: How did we reach this point where healthcare costs in the U.S. are so astronomical, and how does our system compare to socialized medicine?
The Evolution of Medicine as a Business Enterprise
Several key factors have driven the transformation of healthcare into a profit-oriented industry in the U.S.:
- Technological Advancements
Innovations like robotic surgery and precision medicine have improved care but also increased costs, with hospitals and manufacturers competing for profit. - Insurance Industry Expansion
The rise of employer-sponsored insurance after World War II created a system where insurance companies became intermediaries, driving a focus on profitability. - Fee-for-Service Model
Providers are incentivized to prioritize volume—more tests, treatments, and procedures—rather than outcomes, inflating costs unnecessarily. - Pharmaceutical Industry Growth
High drug prices and aggressive marketing campaigns by pharmaceutical companies have turned medication into a lucrative business, often at the expense of affordability. - Privatization and Competition
Healthcare facilities compete for patients by offering luxurious amenities and cutting-edge technology, often prioritizing appearance over equitable access.
Lessons from My Experience
Being on the receiving end of healthcare gave me a deeper appreciation for the complexities patients face. While I was fortunate to have insurance coverage, many Americans are not as lucky. Millions are left to navigate a system that often prioritizes profit over people, creating disparities in access and outcomes.
| Aspect | U.S. Healthcare (Market-Driven) | Socialized Medicine |
|---|---|---|
| Funding | Primarily through private insurance | Funded by taxes |
| Access | Tied to insurance or income | Universal, regardless of income |
| Cost Transparency | Highly opaque; often unpredictable | Centralized control for predictable costs |
| Innovation | Rapid but expensive | Steady and cost-efficient |
| Equity | Significant disparities | More equitable, though budget-constrained |
Socialized systems, such as those in Canada or the U.K., prioritize universal coverage and preventative care. While wait times for elective procedures can be longer, basic healthcare is guaranteed for all citizens, reducing overall societal costs.
The Takeaway
The U.S. excels in innovation and patient choice but struggles with affordability and equity. My journey as both a physician and a patient highlights the need for a balanced approach—one that combines the strengths of market-driven healthcare with the accessibility and cost control of socialized systems.
The lesson is clear: healthcare should prioritize people over profit, ensuring that every individual can access the care they need without fear of financial ruin.
This perspective can hopefully be a powerful catalyst for change, sparking dialogue about how to build a system that serves everyone—patients, providers, and society at large.
Author: Laurence Tabanao Gayao MD, FAAFP, BCEM
