Steward Health Care… a catastrophic unraveling of vital care at the hands of inconceivably selfish leadership. Cascading harms in every direction. And harming both patients unable to care for themselves and the workers watching them die.
You can’t provide decent health care with a profit motive. Everyday decisions become a choice between nurse availability and the bottom line. While non-profits must also closely manage finances, there are no profit-taking stockholders.
That said, the CEO of non-profit Mass General Brigham enjoyed compensation of $6M in 2023.
The ethics of caring for people and the drive to maximize profits or personal income are diametrically opposed to each other. Worst case, you bankrupt the organization, transfer the cost and pain onto patients, employees, suppliers and so on, surround yourself with lawyers, resign, and keep your private jet handy for a quick getaway.
Tidy… and hideously ugly.
Here is a recent Boston Globe Spotlight Article with all the sordid details. A tale of greed as old as time, enabled by technology and a culture of avarice.
2025-01-16 Addendum from the NYTimes How a Company Makes Millions Off a Hospital Program Meant to Help the Poor: “…Even though the drug had a list price of about $2,700, the hospital that owned the cancer center billed Mrs. King’s insurance company $22,700. Her insurer paid $10,000, but the hospital wanted more… She had unknowingly sought care from a hospital that participates in a federal program allowing it to buy drugs at a steep discount and charge patients and insurers a higher amount, keeping the difference.”
I love the way that you have redone the website. I think that it is a great to link in articles by others – like the Chris Hayes article. This does a few things. By linking with others, you drive some attention to your work, you recognize others for related contributions and really help create a community around the ideas that you generate and that are of interest.
I understand the well-founded ethical critique of capitalism. I wonder whether this would be stronger if it also leverages the some of capitalism’s strengths. I think that you can be an anti-capitalist while also recognizing that it may be one of the greatest forces in improving the state of living for the most people. Are there better systems – sure. Are there systems that provide more benefit to people, spiritually and as whole persons? Absolutely. Are they as scalable as capitalism? Perhaps, but I am not sure that we have seen it. Can capitalism, like any system, be abused? Absolutely. Is it being abused? Absolutely.
At the very least, dealing with capitalisms strengths may also help engage those who are most likely to be able to integrate ethical considerations into the system.
I am concerned that the term “unfettered capitalism” is a strawman. Certainly, there is an argument that we give too much homage to capitalism. (I am writing this the day after Trumps second inaugural, so I am very struck by this today). It is treated as an unfettered good, which is wrong. It is even deified. These are important points, and I think that it is what you are really focused on. Capitalism without a strong ethical foundation may default to an ethic of extraction. But I am not sure that this is necessarily an inherent feature of capitalism (though it may be). I think that the impact of capitalism without ethics is one of the most important things that this website brings to the discussion. I guess I would like to explore whether there is such a thing as “ethical capitalism?” Similarly, how can the positive aspects of capitalism be maintained and the negative factors be mitigated. If capitalism only has negative attributes, is there an ethical question to consider regarding what system is available to for the needs of a growing and complex world.
To me, it seems that there is a place for ethical capitalism, but I am not sure how to integrate the two concepts (ethics and capitalism) together. One thing that is clear from the current environment is that excess wealth is an inherent danger and must be reined in. No one person should control more wealth than the GDP of many countries. There is a role for regulation. There is a huge role for education. As you point out, the “ethics of caring for people and the drive to maximize profits or personal income are diametrically opposed.” I think that you can emphasize that the idea is profit maximization as a narrow focus, or that profit should be more broadly defined to include all stakeholders. Perhaps, part of the problem with capitalism is to drive for that extreme. Is it the stoics that see moderation as a cardinal virtue. We have lost sight of this in economics (but also in religion and politics). If religion is an ethical framework, (not sure that it can be defined this way), there can certainly be extremes in an ethical system.
I think that it is important to remember that there are always countermeasures. Quantum computing may break the hash tags required for cryptocurrencies, but a more complicated cryptocurrency will be developed that uses quantum computing. Yes, this is capitalism at work, (Schumpeter’s concept of creative destruction comes to mind), but it is also descriptive of the natural process. I have no doubt that the Trump regime will result in blowback against the Oligarchs. Cutting regulation and taxes will ultimately result in the reverse. People and systems overplay their hands. The discussion of ethics is central to both driving change and defining the structure of the future.
Thanks for your thoughts, Robert — deeply insightful and informed, as always!
You’re right for sure, capitalism itself is not the problem as long as it’s reasonable and prioritizes stakeholders, e.g., close and extended attention from a doctor during an annual physical, vs. a for-profit healthcare operation allowing <10 min. If you can afford it, you can get a concierge doc an extra $5-$7K/yr, cash. But unless you have the money, our own health is secondary to those with money, and in the case of denied claims, to money itself.
Yes, social self-correction and adaptation are disruptive to subsumed ethical systems, which in turn are critical for social stability. Thus, a conflict arises between inflicted change (like the LA fires or deportation), and subsumed infrastructure (limited roads & water, or DACA).
Without adaptation, stability is doomed, like hardened political ideologies. Yuval Noah Harari talks about this in Nexus. Without social systems and ethics, either fascism or anarchy rule. Neither of which is any fun.
Thus, my motivation to work on this site!
What is a pluralistic ethics that allows for competing cultural and belief systems to both adapt to changing circumstances and coexist peacefully. What would such a social contract look like? A massive update to Rousseau and Rawls?
Yes, and it must take technology and social networking into account.