Commercialization of Healthcare and Its Consequences: The US Experience

Abstract

Despite possessing exceptional scientific and clinical capacity, the United States continues to underperform in terms of health system outcomes. This paper analyzes the adverse consequences of decades of market-oriented policy approaches that have incentivized profit-seeking practices among insurers and healthcare providers. Policymakers have outsourced substantial portions of publicly funded coverage for low-income populations (Medicaid) and for individuals aged 65 years and older (Medicare) to private insurance companies, with the result that these firms now derive the bulk of their revenues from public funds. This shift has increased public expenditures while constraining patients’ effective access to care. Despite substantial evidence of corporate misconduct, companies legally obligated to prioritise shareholder interests—and, more recently, private equity firms whose strategies are driven by short-term profit maximisation—have gained control over clinical resources that are critical to the functioning of the health-care system. The Biden administration rescinded some of the most harmful policies of Donald Trump’s first term, expanded insurance coverage for low-income Americans, and introduced limited measures to regulate prescription drug prices. By contrast, following his return to office, President Trump has intensified pressures on public health, reduced Medicaid funding by US$990 billion to finance tax cuts for wealthier populations, and accelerated the privatization of Medicare. Under these conditions, stricter regulation of profit-driven practices remains possible at the state level, and the medical profession bears a responsibility to oppose policy trajectories that undermine population health. However, addressing the current crisis requires deeper, structural reforms that would liberate health insurance and care delivery from the dominance of commercial interests.