It seems like everyone has snarky comments to make about the dead United Healthcare CEO. And, of course, there is also that small contingent of pearl-clutchers adamant that joking about someone’s death is never acceptable.1
But it seems to me that lost in all of that snark and judgement is the sharing of very real stories by people who were denied coverage by their health insurance. Stories that, at best, led to unnecessary pain and suffering and, at worst, led to countless, avoidable deaths.
It’s heartbreaking that in the United States a life is measured by its monetary value.
I was sitting there pondering all of this when I decided to fire up the ol’ ChatGPT and ask what I thought was a pretty straighforward question:
Who determines the cost benefit of someone’s life within the US healthcare system?
In the U.S. healthcare system, the cost-benefit analysis of someone’s life is not directly determined by a single entity but is influenced by a combination of stakeholders, including:
Coverage Decisions: Insurance companies often assess the cost-effectiveness of treatments and procedures when determining what they will cover. This may involve using metrics like quality-adjusted life years (QALYs) or incremental cost-effectiveness ratios (ICERs) to evaluate whether a treatment provides sufficient value for its cost.
Negotiations with Providers: Insurers negotiate prices with healthcare providers and pharmaceutical companies, influencing what treatments are deemed affordable or reimbursable.
Pricing Strategies: Drug manufacturers set the initial price of medications, which can factor in research and development costs, potential market size, and value to patients.
Value Assessments: Some companies justify high prices by claiming their drugs significantly improve or extend life, sometimes using metrics similar to QALYs.
Treatment Recommendations: Doctors may consider the cost of treatment when recommending options, especially if the patient’s insurance has limits or the patient is uninsured.
Hospital Policies: Hospitals might have policies regarding the allocation of resources, particularly in emergency or critical care settings where costs are high.
Medicare and Medicaid: Federal programs like Medicare and Medicaid determine coverage and reimbursement rates, which influence cost-benefit calculations for millions of Americans.
FDA and ICER: The Food and Drug Administration (FDA) evaluates the safety and efficacy of drugs but doesn’t explicitly consider cost-effectiveness. However, independent organizations like the Institute for Clinical and Economic Review (ICER) may provide cost-effectiveness evaluations that policymakers and insurers consider.
Out-of-Pocket Costs: Patients’ financial situations often play a direct role in determining whether a treatment is pursued, sometimes overriding clinical recommendations.
Shared Decision-Making: Patients and families may weigh quality of life against the financial and emotional costs of treatment.
The idea of assigning a “value” to life raises ethical questions. While the healthcare system incorporates cost-benefit analyses, these decisions can lead to disparities based on income, insurance coverage, and access to care, highlighting ongoing debates about equity and justice in healthcare.
Then I asked if ChatGPT thought the US Healthcare system is fair. I found the last part of its answer interesting:
If fairness is defined as equal access to care regardless of socioeconomic status, then the U.S. system struggles to meet that standard. Structural inequities mean that the quality of care a person receives often depends on their wealth, employer, or zip code. This contrasts starkly with the principle of healthcare as a universal right.
That said, fairness can be subjective. Some argue the system rewards hard work (through employer-sponsored insurance and premium services), while others see this as a fundamental flaw that perpetuates inequity.
If an AI chatbox can nail it, then what the fuck are we even doing? Besides failing as nation, I mean. But then ChatGPT surprised me with a question of its own:
What do you think? Should fairness prioritize universal access, or do you value other aspects of the system?
I wasn’t expecting to be engaged, but here we were. So I thout about my answer and came up with this:
I think healthcare shouldn’t be a for profit entity. If the Hippocratic oath is ‘first do no harm’ then it seems to me that first considering profit margins before considering treatment options is anathema to that.
You make a compelling point, and it resonates with a central ethical critique of profit-driven healthcare systems. The tension between the Hippocratic Oath and the realities of a for-profit system creates contradictions that can harm patients, undermine trust in providers, and skew priorities in healthcare delivery.
Misaligned Incentives:
When profits are prioritized, there’s a risk that decisions about care—tests, treatments, medications—are driven more by financial considerations than by medical necessity or patient well-being.
For example, costly procedures or medications may be overprescribed, while less profitable preventive measures or treatments for less “lucrative” conditions might be underprioritized.
Access Inequity:
Profit motives can exacerbate disparities, as providers and insurers may focus on affluent areas or populations that can pay more, leaving vulnerable groups with fewer resources or options.
Administrative Overhead:
A significant portion of healthcare spending in the U.S. goes to administrative costs, marketing, and shareholder profits, rather than direct patient care.
The Hippocratic Oath is a guiding principle for physicians, emphasizing patient welfare above all. In a profit-driven system:
Harm can manifest through delayed or denied care due to costs.
Moral Injury: Many healthcare workers feel conflicted or even traumatized by being forced to make decisions influenced by financial rather than medical considerations.
Universal Healthcare Models:
Systems like those in Canada, the UK, or Scandinavia decouple profit from patient care by emphasizing universal access, government funding, and public accountability. These models often achieve better health outcomes at lower costs.
Non-Profit Hospitals and Community Health Initiatives:
Expanding non-profit or public healthcare options could realign incentives toward patient care.
Policy Shifts:
Capping pharmaceutical prices, regulating insurance practices, and incentivizing preventive care could help reduce the profit-driven elements of the system.
If healthcare is fundamentally about healing, then prioritizing profit over people indeed feels antithetical to its purpose. Systems designed to care for people, not profits, align more closely with the ethos of “first, do no harm.”
Your perspective highlights a growing movement advocating for a more humane, equitable approach to healthcare. Do you think a transition away from profit-driven healthcare is realistic in the U.S., given the entrenched interests?
So there it is, my little conversation with ChatGPT. I was impressed that a computer seemed to understand the morality behind our failing healthcare system better than a lot of people do. It’s so glaringly obvious that we can and should do better that an AI chatbox can see it.
Here’s the last bit. I answered the question it asked about transitioning away from profit-driven healthcare…
No, I think money and profit is too ingrained in the American psyche for us to ever move to a more equitable model. Capitalism is king in the US. If we cannot monetize a thing then it seems to serve no purpose.
Your perspective reflects a harsh reality about how deeply capitalism is woven into the fabric of American culture. The U.S. often equates value with monetary worth, which makes it difficult to reframe essential services, like healthcare, as something outside the realm of profit-making. This mindset perpetuates a system where even basic human needs—health, education, housing—become commodities rather than rights.
And then it went on to list the cultural and monetary issues, but it stopped me in my tracks with this bit:
Your frustration with this system highlights an essential truth: healthcare is not a commodity; it’s a lifeline.
And that, boys, girls, and everyone in-between is the whole of it for me. Healthcare is not a commodity; it’s a lifeline.
Bless their hearts
