A Money-Hungry World: Bioethics & Monetizing the Healthcare Industry

Writer: Cathy Li
Editor: Allison Liu

As a Canadian, I’m proud and grateful for our free healthcare system. However, it’s not easy to overlook what’s going on across our border, and around the rest of the world. Healthcare is a basic human right that everyone deserves access to. So when did it turn into a business? When did we let our greed for money wash away our compassion in caring for those who need help? To put it bluntly, we have monetized the healthcare industry through the impossible costs that perpetuate socioeconomic inequality, the exploitation of patient information, and the abuse of the vulnerable. 

I want to address the disparity between socioeconomic classes and the unbreakable cycle of poverty first, since poverty is clearly one of the root factors involved in the monetization of the healthcare industry. The situation is straightforward: if you’re rich, you have healthcare, and if you’re not, you don’t have healthcare. Simply stepping into the hospital can cost you a fortune. This might be a bit of an exaggeration, but it illustrates the severity of this issue. The lower to middle class, faces a dilemma: neglect their health or scramble to pay their bills. And ultimately, these issues come down to the government, who just can’t figure out how to pay for their country’s healthcare. As a result, firms are outsourcing low-wage workers to avoid providing health benefits, and schools and environmental campaigns are depleted of resources because it is all going to healthcare (Cutler). What’s unfortunate is that the healthcare industry takes advantage of the country’s systemic poverty and the government’s inability to regulate healthcare prices. Pharmaceutical companies continue to put profits before patients through price gouging and other unethical price manipulations. For example, the U.S. list price for insulin is 10 times higher than Canada (Cutler). \. As well, prestigious hospitals are charging several times more than smaller, community hospitals for the same services (Cutler). Big actors like these star hospitals and the government are leveraging the high demands for healthcare, compromising the vulnerable communities of their nation solely for monetary gain. Administration is another major contributor to this issue. America is spending one-third of its healthcare funding on administration, creating entirely new and unnecessary occupations – like medical record coding – that do not exist in any other country (Cutler). Lastly, the U.S. is simply too advanced for its own good. Its overwhelming “love” for medical care shows through the abundance of sophisticated technology they have invested in. It sounds great at first, but who’s going to pay for it? There’s a crucial balance between “high-technology” and “routine care” in the medical field (Cutler). You can have as many doctors as you want and as much advanced operative machinery, but it all becomes ineffective when no one is there to implement routine care for patients. In Canada, we have a limit to the amount of this high-tech care, forcing us to allocate our resources wisely. Without sufficient policies like these in America, you begin to notice that America’s healthcare is not as progressive as you thought.

23andMe is a biotech company based in San Francisco that provides direct-to-consumer genetic testing services, and they exemplify the tendency of  corporations prioritizing profit over consumer privacy and well-being. 23andMe had a share value of $6 billion, but that all went down the drain when it suddenly lost 98% of its value due to a drop in sales and rising interest rates that made it difficult to raise funding (Enright). Ironically, the drop in sales was in part due to a previous data breach that targeted Jewish and Chinese customers, which is similar to the situation now (Lindner, “As 23andMe Struggles”). After the decrease in profit, all of its independent board members resigned in September (Enright). But it’s the impact 23andMe’s losses have on previous or current customers that concerns me. The company has admitted that “people who have submitted tests to discover ancestry lines or for health care research can potentially leave their information vulnerable to threat actors” (Lindner, “As 23andMe Struggles”). It’s important to reiterate that this isn’t the same as revealing your credit card number, email password, or Social Security number. Those things can be fixed – you just get a new one. This issue is a big deal because the human genome is a big deal. Your DNA discloses a tremendous amount of information about you. And you can’t just get a new DNA. Furthermore, the genome doesn’t change, but technology does, so while technology becomes more advanced, our ability to understand human DNA also increases. Even if it’s unlikely, a threat actor with experience and knowledge in this field could do so much with the millions of DNA information compiled in 23andMe. It’s disappointing that 23andMe could have such poor regulation, all because they’re going bankrupt. 

Perhaps I have already painted a clear enough picture of America’s healthcare system, but we’re missing out on one important perspective: mental illness. The abuse of those who are less protected comes in many forms in the healthcare industry – America’s crazy healthcare costs are an example of abusing the poor. But I never knew that some corporations would be so shameful as to exploit those suffering from mental health issues. Acadia Healthcare is a for-profit behavioral health company. They are a leading provider of residential mental health and substance abuse facilities. Around the beginning of September, a New York Times investigation revealed the unethical and plainly disturbing practices of Acadia Healthcare: intentionally luring patients into their facilities and holding them against their will with no medical reason until lawyers intervened (Lindner, “Exposing a Hospital”). Why? Acadia wanted to wait until the patient’s insurance ran out so they could maximize profits for the hospital. 

The story of Kathy Mackenzie illustrates the circumstances clearly. Kathy is a 51-year-old school social worker who has been struggling with bipolar disorder since her 20s. In 2020, her symptoms started to act up again, so her mother and sister took her to a doctor. The doctor in the emergency department directs her to another hospital to get a psychiatric evaluation, and that hospital happens to be Acadia Healthcare. At Acadia, she was asked a few standard evaluation questions, which she answered with no problem; however, Acadia seemed to think otherwise. 

Kathy wasn’t oblivious to the suspicious behavior of Acadia. She said she “tested” how they might “treat her” by asking the staff if she could use the restroom during the questionnaire. To her surprise, the staff led her to another room with around 10 people in it. Kathy claims she could hear the door lock and instinctually, she began screaming. She was institutionalized against her will in the North Tampa branch of Acadia Healthcare. 

For the next few days, she was trapped there, unable to reach her family. When she is eventually able to call her sister, they devise a plan to get her out of there. This means staying calm so the institution doesn’t use her emotions against her, which is clearly hard to do when you're trapped in a dehumanizing environment against your will. She also kept a journal, and she expressed how writing in this journal was the one thing that kept her grounded. Eventually, her mom and sister worked to hire a lawyer and get Kathy out. Kathy described her traumatizing experience as “surreal.” She stated, “It was like something that felt like it’d taken months and it was almost exactly a week.”

Acadia’s procedures are based on augmenting payouts, consequently neglecting patient care. In fact, Acadia goes out of their way to find these patients, market directly to them, and encourage them to skip the ER and go straight to Acadia’s services. Then, they capitalize on the information imbalance and confusion of the patient. Acadia is trying to keep the patients for as long as possible because they are pursuing the patient’s insurers – but the patient doesn’t know that. Acadia takes advantage of this by exaggerating the patient’s symptoms, arguing that they are “unwell,” and scrutinizing every action of the patient. To give you a scope of Acadia’s motives, in Kathy’s case, Acadia was charging her insurance $2,200 every single day (Bennhold). Imagine how much Acadia would make with several hospitals full of these patients. Acadia found a loophole in the policies and laws regarding this issue, allowing them to maximize their profits. In response to these speculations, Acadia came out to deny all claims that they put “profits over patients.” Whether this is true or not, the fact that Acadia’s patients felt any sort of threat is already something to worry about.

While I illustrated three main concerns with the healthcare industry in the U.S., I did so in a very surface-level manner. I summarized issues that are so big and much more important than a few simple paragraphs. Bioethics is a pervasive problem that I hope to spread more awareness on, especially as we see this bridge forming between bioethics and business. In my opinion, the first step to combatting this challenge goes back to inequality. We need to stop focusing on our differences and highlight our commonalities instead.

Works Cited

Cutler, David. “The World’s Costliest Health Care.” Harvard Magazine, May 2020, www.harvardmagazine.com/2020/04/feature-forum-costliest-health-care. 

Enright, Merritt. “Inside the fall of 23andMe.” CNBC, 23 October 2024, https://www.cnbc.com/2024/10/23/inside-the-fall-of-23andme.html.

Lindner, Emmett. “As 23andMe Struggles, Concerns Surface About Its Genetic Data.” The New York Times, 5 October 2024, https://www.nytimes.com/2024/10/05/business/23andme-dna-bankrupt.html#. 

Lindner, Emmett. “Exposing a Hospital Chain’s Disturbing Practices.” The New York Times, 9 September 2024, https://www.nytimes.com/2024/09/09/insider/acadia-healthcare.html. 

Bennhold, Katrin. “The Profitable Business of Holding Patients Against Their Will.” The New York Times, 26 September 2024, https://www.nytimes.com/2024/09/26/podcasts/the-daily/acadia-hospital-trapped.html