During part of my career I held an executive director's position in a hospital. We had purchased a neighboring hospital, a nursing home, and were looking to purchase other hospitals. I learned something about medicine in the U.S., and about how hospitals are run here.
I learned that many hospitals in the U.S. were started by religious denominations. These hospitals served in altruistic fashion and served unmet needs in many communities for many years. Around the 1960s or so things began to change. As more and more hospital boards of directors saw a change in membership, no longer were the boards made up of people dedicated to the specific religion or denomination that founded the hospital, but they began to see this as a business. Some unscrupulous board members saw it as a golden chance to feather their own nest.
As negotiations got underway to merge hospitals or have a super organization buy them out, things were sometimes manipulated by board members to make money for their businesses or their investments. No longer were the hospitals tied directly to the religious organization or denomination. Stocks were sometimes bought and sold in the process, and some board members were stock brokers, stock investors, etc. The conflict of interest was visible only to people on the inside of the hospital operation.
It all looked like a win-win situation. The religious denomination got out from under the complex and burdensome responsibility of running the hospital, and the new, super operations had dazzling new equipment to show off and money to advertise and do PR.
But not-for-profit and service organizations do not always translate well into a business or to use business tactics. As a consultant for years I had many times cringed when I would hear a board member sincerely and honestly think he was leading the way by stating, "We need to run this more like a business!" It seems like a natural and good observation. But when altruism is replaced by a business model using business-only tactics, something often suffers. And what often suffers is the client, patient, or needy person who is to be served by the not-for-profit organization or institution.
It should also be noted that many not-for-profit organizations and institutions that were doing just fine before this business take-over craze, have gone down the tubes since. It became very apparent that "running it like a business" did NOT work. This is not true for all, but for many. It seems good and logical to hear, but it is an easy approach to complex issues. And the altruistic side cannot be ignored.
However what really has added to the decline in the relative health care offered in the U.S. is that these huge hospital conglomerates have teamed up with pharmaceutical corporations to influence and buy legislators and legislation. As a result, health care in the U.S. is inferior to that of Germany and France. Americans are loathe to read that statement. But it is true. Using any qualitative measure, we have inferior health care in the U.S. than much of the industrialized world. And it shows most obviously in our much shorter life expectancy and our much higher cost of doing health care.
I am using every experience and all my knowledge gained from being an executive associated with a hospital when I say to you that health care in the U.S. has now come full circle. From the good will and altruism that founded much of our health care and hospitals in the U.S., we have now morphed to a point where this former altruism is being used to buy legislation and propagandize you to advocate against your best interests.
I have no self-interest in stating any of this, but to simply share my experience and knowledge with you.