04/10/2025
Mind, Body, Spirit with Dr Ashish Sachdeva:
Sold Out: The Ultimate Betrayal of the Patient
By Ashish Sachdeva
When I reflect on the state of our healthcare system, I can’t help but feel we’ve reached a breaking point—a moment where the very principles of medicine have been sold out. What was once a noble calling has been overtaken by unchecked greed, systemic failures, and a betrayal of the very patients we pledged to serve.
Everywhere we turn, we see evidence of this erosion. Steward Health Care offers a striking example. In 2010, private equity firm Cerberus Capital Management acquired six Catholic hospitals in Massachusetts. For five years, these hospitals maintained an illusion of stability, abiding by oversight requirements set by the state attorney general. But as soon as the oversight ended, the land under these hospitals was sold in a billion-dollar deal to finance further acquisitions. The result? These hospitals were saddled with massive rent obligations for land they had once owned outright. Staffing levels plummeted, basic resources like clean linens became scarce, and mortality rates spiked. Carney Hospital, once a cornerstone of care, became known as “Carnage Hospital.”
By May 2023, Steward filed for bankruptcy. Many of its hospitals closed or were sold off, leaving communities devastated. And yet, Cerberus walked away with $800 million in profit. This isn’t an isolated incident. Today, private equity owns over 450 hospitals in the U.S., as well as a third of staffing in emergency departments. Their strategy is clear: extract as much profit as possible, often by cutting costs and compromising patient safety.
But the betrayal doesn’t end with private equity. Even nonprofit hospitals—institutions historically created to serve the public—have adopted the same profit-driven tactics. Providence Health, one of the largest nonprofit systems in the U.S., was caught aggressively pursuing debt collections from patients eligible for free care. Allina Health took it further, refusing treatment to patients with unpaid bills, even children. These organizations, founded on principles of charity and care, now chase profit with the zeal of Wall Street.
The problem extends to nonprofit insurers as well. Many believe that nonprofit healthcare would solve these issues, but the reality is starkly different. Blue Cross Blue Shield (BCBS), for example, is a federation of 33 independent, community-based companies covering over 110 million Americans. Most operate as nonprofits, yet their practices rival those of for-profit corporations.
Take Blue Cross Blue Shield of Michigan, which controls 57% of Michigan’s health insurance market. In 2022, its CEO, Daniel Loepp, earned $16.9 million in total compensation, including a $13.8 million bonus. Similarly, Blue Cross Blue Shield of Illinois dominates 80% of Illinois’s market, while Blue Cross Blue Shield of North Carolina holds a staggering 97% of the individual insurance market. Their nonprofit status is a mere tax designation—it doesn’t translate into lower costs, better services, or a commitment to patients over profits.
Nonprofit does not mean altruistic. These companies wield monopoly-like power, pay executives obscene salaries, and exploit their market dominance, often to the detriment of the very people they are supposed to serve.
The betrayal continues in Medicare Advantage, where insurers race to code as many diagnoses as possible—not to improve care, but to inflate government reimbursements. Doctors are incentivized with bonuses to add diagnoses, and patients are bribed with gift cards to attend checkups. The result? Billions of dollars in Medicare overpayments, drained from taxpayers and diverted from meaningful care.
These failures have real consequences. I recently treated a woman who delayed seeking care for a urinary tract infection because she couldn’t afford her high-deductible plan. By the time she sought help, the infection had spread to her bloodstream, requiring a week-long hospitalization and nearly costing her life. Tragically, this woman worked for a nonprofit hospital—the very type of institution that should have protected her from such a scenario.
Meanwhile, government oversight remains woefully inadequate. Antitrust laws, designed to prevent monopolies and protect consumers, are routinely ignored. UnitedHealthcare, for instance, owns its pharmacy benefit manager (OptumRx) and pharmacy operations (also branded as Optum), skirting antitrust regulations with mere name changes. Hospitals are reimbursed 3–10 times what independent physicians receive for the same procedures, incentivizing hospitals to employ doctors and profit from their referrals, blatantly bypassing Stark Laws designed to prevent self-referral abuse.
This is not just a betrayal by corporations or the government—it’s a societal failure. As Willie Sutton, the infamous bank robber, once said, “Why do you rob banks? Because that’s where the money is.” Today, healthcare has become the ultimate bank, with insurers, private equity firms, and even nonprofit institutions exploiting the system to enrich themselves.
But let’s not absolve ourselves as physicians. Many of us have benefited from this broken system—selling our practices to private equity, accepting incentives from insurance companies, and then decrying the very system that sustains us. Hypocrisy will not solve this crisis.
Medicine is not just a business; it is a sacred promise. A promise to care for patients in their most vulnerable moments, to prioritize their needs above all else, and to act as stewards of their trust. If we continue down this path of unchecked greed and systemic exploitation, we risk losing more than our professional integrity—we risk losing the trust of our patients entirely.
Now is the time for action. This betrayal must not stand. We need to demand better enforcement of antitrust laws, greater transparency from hospitals and insurers, and policies that prioritize patient care over profit. The soul of medicine is at stake, and if we don’t fight for it, who will?
This is our moment to reclaim what has been lost. Let us not squander it.
