See Healthcare Differently: Why ethics (not economics) should guide the system

“If you want to make small changes, change the way you do things. If you want to make major changes, change the way you SEE things.”

- Don Campbell (Canadian rancher on regenerative agriculture)

Healthcare today feels unsustainable - for everyone. Patients are fed up with how hard it is to get care for even mundane issues, much less complex medical crises. Roughly half of practitioners acknowledge at least moderate levels of occupational distress. And administrators are worn out from endless reimbursement, compliance, and regulatory battles.

The US spends twice as much on healthcare as any other country. Yet, in the Commonwealth Fund’s 2024 comparison with nine peer countries in five key domains of health system performance -access to care, care process, administrative efficiency, equity, and health outcomes- “the U.S. continues to be in a class by itself in the underperformance of its health care sector.”

For decades, healthcare has been shaped by an industrial lens – consolidating, vertically integrating, standardizing and bureaucratizing. But those strategies have largely failed to deliver on their promises of better care coordination, improved outcomes, or lower costs.  Upholding professional oaths is getting harder in corporatized environments, and that is having an impact on all health professionals.

Surveys from 2024 suggest anywhere from 20–63% of health professionals plan to leave their positions within a year - citing toxic culture, unmanageable stress, and lack of support. Meanwhile, a recent Elsevier survey found that 25% of U.S. medical students have considered leaving medicine altogether, with more than half viewing medical school as a stepping stone to nonclinical careers. Yet we desperately need to expand this invaluable workforce because of the impending demand in services from aging baby boomers.

What would happen if we saw things differently - if we reclaimed healthcare as a human endeavor, not just a business transaction? 

“Different” means flipping the script on the industrial mindset of healthcare delivery. It means acknowledging that healthcare must be human-sized and that healing is best when it is personal, thoughtful, participatory, restorative, compassionate and connected. None of that happens in a corporatized, bureaucratized workflow, which puts the needs of the organization before the needs of the patient.

How do we flip the script?

Re-establishing the societal contract and human commitment between institutions, their employees, their patients, and their communities is key. The business and clinical sides of medicine have long been at odds. To restore compassion, both sides must come together to understand each other, repair their ruptured relationships, realign incentives, and renegotiate the covenant of care.

Reasserting the ethical foundations of healthcare is the first step, the four principles of which are:

• Beneficence: putting the patient first.

• Nonmaleficence: to do no harm.

• Justice: ensuring fairness in medical decisions.

• Autonomy: honoring a patient’s right to choose.

In taking our oaths, health professionals assumed a moral obligation to uphold those ethical principles, and that standard of care, for our patients and for our profession.

It's time to ask more of healthcare leaders - not just clinicians. Imagine if every executive in hospitals, insurance companies, pharmacy benefit managers, private equity firms, or device manufacturers swore a version of the Hippocratic Oath - one that commits them to the wellbeing of patients, workforce, and communities, not just shareholders.

Oath-taking assumes responsibility and implies accountability. The structure of accountability for licensed healthcare professionals is robust and clear, guided by our oaths and ethics. We need to build a parallel system of accountability for the other half of the healthcare team that is equally robust and persistent.

For years, healthcare has been an uncomfortable – sometimes disrespectful, if not openly hostile – alliance between the “no margin, no mission” mindset of administrators and the “patient first, always” mindset of practitioners. That power struggle serves no one and wastes precious resources better spent in the already difficult work at hand. Negotiating shared values within and across the traditionally siloed boundaries of every healthcare organization, beginning with clinics and hospitals and eventually expanding to include payors, pharmaceutical and device corporations, and more, is critical.

Finally, each of us must become comfortable with diplomatic defiance: knowing when and how to speak up or push back against practices that fail to serve our patients or threaten our ability to uphold our oaths. It is a skill we can learn, and a product of values clarity, self-awareness, reflection, practice finding our voices, and creating coalitions for safety in numbers.

We need to challenge our assumptions about what good healthcare looks like. The current model no longer serves. It’s time to see differently - to orient our way toward a more humane system, with our moral compass as our guide, and patients as true north.

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