For the New Year, it is time to ponder- why is there still no organized outrage over the ongoing incompetent, uncaring, self-interested, conflicted, and often outright corrupt leadership of health care organizations we have documented incessantly on Health Care Renewal?
For example, just a few days ago, we documented a series of cases in which large US and multinational health care organizations settled cases alleging they deceptively marketed drugs so as to exaggerate their benefits and conceal their harms, bribed doctors and officials outside of the US, gave kickbacks to US doctors, defrauded the US government, and monopolized markets for drugs, yet few leaders, and no top leaders of the companies involved suffered any negative consequences for authorizing, directing, or implementing these activities. We have discussed many previous legal settlements involving similar bad behavior and similar impunity by the leaders of the organizations involved. Again and again we have discussed how large organizations, often but not always drug, biotechnology and device companies, have manipulated the scientific literature (e.g., see examples of manipulation of clinical research, suppression of clinical research, and specific practices such as ghost-writing of apparently scholarly articles to benefit vested interests.) We have discussed overblown compensation that made top managers and other organizational insiders rich without any rationale other than their ability to take such money off the top. Yet in the US, despite ever rising costs presumably provoked by such leadership, without corresponding improvements in quality or access, there is still no organized movement for change.
The problems in US health care, however, seem to parallel problems in the larger society, and the world at large. We have discussed parallels with bad leadership of financial firms, including the firms that drove us into the global financial collapse/ great recession, and to continuing income stagnation, recession, austerity, and decreasing opportunity for the poor and middle class around the world.
Yet parallel questions are just beginning to be
asked about larger related political economic problems. Recently,
historian Brad DeLong attempted to address the question, "why next to
no reaction to the second gilded age?" (See this.).
Unfortunately, while he could demonstrate two powerful political movements that
opposed the first Gilded Age, he was completely at a loss to explain why
there has been no similar organized outrage about the second Gilded Age in
which we exist today. Despite incompetent, uncaring, self-interested,
conflicted, and often outright corrupt leadership of many large
corporations, non-profit organizations, and government agencies only a
few voices, often bloggers like us, have objected.
Economist Mark Thoma
then took up the question, but the best he could do was suggest that outrage
has been moderated because of the existing, if frayed, social safety net, and
because many people nonetheless saw the last two decades as a time of
increasing economic opportunity. (See this.
) He did not address how this view may have been wrong, since the
last two decades were a time of obviously worsening income inequality.
Yves Smith of Naked Capitalism finally offered some insight (see this)
by noting the importance of "propaganda," corresponding, I think, to
the widespread deceptive marketing and public relations, and the use of
covertly paid key opinion leaders to further both that we frequently
discuss. Finally she suggested that people feel powerless because they
see themselves as "atomized individuals," even though they many are
currently being treated as interchangeable parts by the leaders of large
organizations who can control the actions of large number of employees
to further their self-interest.
There must be more reasons. There ought to at least be some organized discussion of these reasons. After that there needs to be some organized action to promote real reform. I conclude the often miserable 2012 with a plea for those who are interested and concerned to come together to create real solutions.
ADDENDUM (1 January, 2013) - see comments by Dr Howard Brody on the Economism Scam blog.
A physician speaker shares 7 essential tips - I recently delivered a keynote in St. Louis to 600 health care leaders from a health system with 20 hospitals, 600 clinics, and 30,000 employees. They told...
12 minutes ago