In a corporate boardroom somewhere, perhaps in more than one or two, there is a cabal of executives and operatives brainstorming. “How can we make clients and patients of children, teens, and young adults?” “How can we make vulnerable populations lifelong consumers of our commodities and services?” “We must get them while they’re young,” one tells the rest. “We must make them forever dependent on us.” “How do we do this?” “We have to make them feel that there’s something wrong with them,” he says. “They’re sick. We can heal them!” one says. “They’re broken. We can fix them!” says another. Then, in a frank moment, the man at the end of the table says, “But not really. Because, really, we’re going to sicken them. We’re going to break them.”
Some readers are probably recoiling at my speculations. How could those devoted to the health and wellness of people think in such a fashion? Don’t doctors take an oath? Isn’t one of the core principles of that oath primum non nocere—“first, due no harm?” This is the source of a core principle of bioethics: the principle of non-maleficence! Without crossing over into therapeutic nihilism, the essence of the principle is basic. Given the nature of an existing problem, it may be better to avoid some course of action or to take no action at all than to risk causing more harm than good. So how does a profession go from principled to unprincipled practice, to organized action that causes harm with the purpose of making clients and patients rather than finding them?
In the early 1970s, a series of federal laws and policies were enacted that changed the way hospitals and medicine worked in the United States. These changes had a profound impact on the health care system, and led to the emergence of large corporate health care systems. The rise of managed care and health maintenance organizations (HMOs) in the 1970s played a key role. HMOs became the dominant form of health insurance in the 1980s and 1990s and their emergence is associated with the consolidation of health care providers into large corporate health care systems. Large corporate health care systems were able to negotiate discounts with health insurance companies, reduce costs by centralizing services, and provide a wide range of health care services to patients.
The changes in law and policy in the early 1970s thus set the stage for the transformation of the health care system from a fragmented, locally-based system, in which doctors contracted with public hospitals and clinics and patients, and (honest) doctors delivered only the care the patient needed, to a centralized, corporate-dominated system in which doctors became employees subordinated to the dictates of corporate profit, which drives them to make clients and patients.
The very character of the corporation, recognized as a legal person, legally required to behave as a psychopath, lies at the heart of the atrocities of the medical-industrial complex. Shareholders play an important role in the operation of big corporate health care and medical groups. Health care companies are typically structured as for-profit corporations, which means that they are owned by shareholders who expect to receive a return on their investment in the form of dividends or capital appreciation. The primary responsibility of the shareholders of a corporation is to maximize their return on investment. This can be done by increasing the company’s profits, which are generated by expanding health care services—and this requires not only finding more patients, but also creating them.
The drive to maximize profits in big corporate health care and medical groups incentivizes the development of new technologies and procedures, which in turn leads to increased medical intervention and treatments. The financial resources provided by shareholders can be used to fund the research and development of new technologies and therapies. This can lead to new drugs and surgical procedures that may not be supported by strong scientific evidence. It incentivizes the overuse of medical interventions, even when these interventions may not be needed on objective medical grounds—even when these interventions sicken and break people.(See Disordering Bodies for Disordered Minds.)
Because health care is an industry in the age of corporate power. The problem of over and unnecessary intervention has eclipsed the problem of therapeutic nihilism. Indeed, a new nihilism has emerged, one that sacrifices truth and caution on the altar of acquisition and avarice. The imperative of profit maximization eclipses everything else. The corporate person is a self-interested entity concerned only with profits for shareholders, a personality developed and codified through various legal and economic theories, at the core of this the shareholder value model. The model is a business philosophy that prioritizes maximizing returns for shareholders above all other concerns. It is based on the premise that the primary purpose of a corporation is to generate profits for its owners through stock value maximization.
Everywhere this thought has occurred (or will occur), knowing the long history of marketing, propaganda, and public relations, namely that business firms can make a thing like this happen by engineering a culture that induces people to believe things that will make those commodities and services obvious to the illusion that makes them necessary (and they know a great many people are vulnerable and will believe a great many things), people are sickened and broken and made dependent on the corporations.
This culture must be one of futility, producing a profound sense of estrangement from the larger social order, its norms and values, its task and purpose, to produce in individuals the nihilism and narcissism that prepares them for reintegration with the corporate logic of consumption, resulting in what President Herbert Hoover long ago called “happiness machines.” The means of manipulating the masses towards these ends is well-tested, developed from the Freudian principles of psychodynamics, refined to be ever more effective, their intent ever more dissimulated by the gathering about the motive the legitimacy of prevailing social institutions, exploiting the deep faith the people have in the authority of health care professionals.
This is why elites have sent up the hue and cry about the crisis of legitimacy in the prevailing social institutions of corporate governance: elites need the sheep to trust the shepherd.
But the shepherd is only interested in eating them, fleecing them, or fucking them.