Opinion – How the American healthcare system puts profits over patients

For most Americans, paying for healthcare without insurance is simply not feasible. Nationwide, 26 million people are uninsured, with an additional one in four Americans underinsured—meaning they have insurance but nonetheless struggle to cover medical costs. As the Trump administration actively dismantles critical research and public health institutions and looks to shred Medicaid, suffering awaits an increasing number of vulnerable people.

Compared with peer nations, Americans spend nearly twice as much on healthcare per person. Unlike in other countries, this increased spending does not result in health gains. The U.S. continues to see higher rates of maternal and infant mortality, chronic disease, and shorter life expectancies—outcomes that disproportionately impact low income and Black patients.

These high costs and poor results are in large part due to profit-seeking; major industry players are happy to see prices rise as long as they get their share. The resulting practices and policies are divorced from what would most improve the health of individuals and communities.

It is within this context that Atlanta’s Grady Health System announced the opening of a freestanding Emergency Room in Union City, Georgia. This area of southern Fulton County has experienced longstanding institutional divestment in various forms, including healthcare infrastructure.

Most recently, Wellstar, a regional hospital system, closed major healthcare sites in 2022, including two hospitals and a number of affiliated clinics. Despite being ostensibly not-for-profit, Wellstar and similar entities around the country seek to maximize revenue while feigning altruism. By hiding behind the financial pressures that caused rural and urban hospital closures, Wellstar sought to appear powerless. Such closures occur frequently in states like Georgia that have refused to expand Medicaid, leaving billions of Federal dollars on the table and hundreds of thousands without medical insurance, making it easy for Wellstar to claim the numbers simply didn’t add up.

Rather than collaboration, the American health system is rooted in competition. In an ecosystem where healthcare is viewed as a privilege for those who can afford it, that competition is often for privately insured patients. Unhappy with their return on investment, Wellstar fled to whiter, more privately insured areas—disregarding the health benefits local residents had gotten from their institutions.

Closure and patient abandonment is not the only option available. Wellstar could, and should, have demanded more resources from local and state governments, the philanthropic community, and other health systems. This is what Grady itself successfully did when facing far greater financial strain in 2009.

With Grady’s plans to expand into this healthcare desert, emergency care will become more accessible to southern Fulton County residents. While offering some crucial and timely interventions, this development has deeper, structural trends at play.

What Drives Health?

To focus solely on clinical interventions is to miss the larger picture. Social determinants of health—health-related behaviors and socioeconomic or environmental factors—drive over 80% of health outcomes. These social determinants are part of an umbrella of  political or structural determinants. Policy decisions overwhelmingly influence a person’s ability to live well.

Systemic racism often manifests as political and institutional divestment from Black communities. Government-controlled health risks like toxic air, extreme heat, unaffordable and substandard housing, hyper-criminalization and underfunded schools create and entrench quality-of-life disparities. By deciding what to fund, where, and for whom, policymakers manufacture vulnerability, leading to preventable suffering and premature death on a massive scale. Those on the losing end of this inequality, like the residents of southern Fulton County, have less wealth and far shorter life expectancy than people in structurally supported areas.

With little political power, enacting the types of structural change required to uproot health inequity remains a colossal challenge for community members. Given a dearth of life-affirming resources coupled with poor healthcare access, health crises remain a predictable result.

Emergency Care

While timely access to emergency care can make the difference between life and death, the majority of visits are unnecessary. Some are better treated in outpatient clinics, where care is cheaper and more efficient, while many are not clinically related at all.

Emergency rooms are a window into failing social systems. Hallways are filled with patients who often have nowhere else to go. A cursory investigation would reveal most of these patients suffer from economic insecurity and lack of access to affordable housing, mental health and substance use treatment and elder care. Unfortunately, hospitals are ill-equipped to meet these long term structural needs, providing—at best—momentary stabilization amidst extreme vulnerability.

On its own, emergency room access reinforces an emergencies-only relationship with the healthcare system and condemns poor, uninsured people to a cycle of healthcare avoidance, emergency health events and catastrophic expenses. A combination of inaccessible, expensive healthcare and unmet basic social needs can result in anything from preventable diabetes-related amputations to untreated high blood pressure resulting in kidney failure. With preventative care out of reach, many patients only encounter the medical system as a last resort, revealing that in the United States, our “healthcare” system is better described as a “sickcare.”

Moving Beyond Exploitation

Our most vulnerable patients face intersecting crises of climate change, unaffordable housing, and inequality. No emergency room, nor any clinical intervention, can address these primary drivers of premature death. It is not until we go “upstream” that we can begin to build a world that rejects the disposability of human beings and enables health. It is social, rather than clinical, medicine that our patients sorely need.

This crisis of care was not brought on by Trump, DOGE or RFK Jr., though they will certainly worsen it. Rather, decades of corporatization and profit-seeking have turned patients into commodities. From private insurance companies to the pharmaceutical industry, hospital consolidation to private equity takeovers, the system turns the suffering of many into enormous profits for the few.

How do we begin to untangle such a complex system with so many vested and powerful interests? It requires a shared moral conviction that health, not just healthcare, is a human right. We must reorient the healthcare system and our society away from individualism and exploitation towards solidarity and care. To confront an untenable status quo, we must embrace a “preferential option for the poor,” coupled with a radical politics that uproots the causes of health inequities.

The centering of investments into long-neglected communities should start at the local level. We must be clear regarding the limited benefits new clinical infrastructure can bring. The opening of a new emergency room alone is inadequate; we must demand elected officials invest in initiatives that move beyond social service provision towards social change.

It is morally indefensible to continue along with neglect and divestment when intentional policy choices can reverse course. This opportunity for change provides hope that we might, together, take part in building a more just world.