Cancer care and the trend to monopolization

Cancer care and the trend to monopolization

I am very interested in oncology. It’s not a theoretical interest; as a person who has been treated for cancer, I have a personal stake in the field. So when I saw an article in The New York Times headlined “Private oncologists being forced out leaving patients to face higher bills,” it caught my attention right away.

The gist of the story is this: Private cancer doctors, in other words, those not affiliated with a large hospital, are unable to survive in the marketplace because of the cost of the medications they must have in stock at all times. (Think chemotherapy drugs.) Hospitals have to buy and stock the same drugs but are able to pay half the price due to a federal program. However, the savings to the hospital are not passed along to the patients, who actually end up paying more for treatment from hospital-based oncologists than from private oncologists.

A secondary factor in the squeezing out of private oncologists is the way that insurance companies reimburse them for treatment:  Hospitals get reimbursed at a higher rate than do the private oncologists, even for providing the same treatment.

The NYT article is worth reading, but it misses the point, most likely on purpose.

The biggest thing being overlooked is that the phenomenon of small businesses being swallowed up by larger businesses is a naturally occurring tendency of capitalism—the tendency towards monopolization. That in this case monopolization is being encouraged by government policies and programs just goes to show that the government is a government of, by and for the big capitalists, despite any lip service given to the value of small businesses.

The next big thing the article overlooks is that whether cancer care is being provided by “private” or “hospital based” oncologists, cancer patients in this country are all receiving treatment under a capitalist paradigm, in which it is considered reasonable for someone to make a profit from treating a life-threatening illness.

The article focuses on “quirks” in the Affordable Care Act, reimbursement policies and drug pricing to explain the trend of private oncology practices moving to hospitals. In actuality, these factors are only accelerating the natural trend towards centralization.

I don’t really feel sorry for the private oncologists who are being forced to work at hospitals as employees instead of being little business owners. No matter how you slice it, I’d rather not be cared for by someone who sees my illness as a source of profit, and who might be tempted to adjust their recommendations for my care based on my ability to pay, or on what drug will be most profitable for their practice, rather than on what is best for me. Of course, there is no guarantee that hospital cancer treatment will be strictly evidence-based either under the current economic system.

One thing is certain, centralizing all aspects of specialized cancer care is generally a good thing for patients. It just makes sense to go to one place for surgery, chemotherapy, labs, scans, and so on. There is no reason why hospital-based care should be less personal or caring than care provided in an office. I deeply appreciated the compassion of my nurses and doctor while being treated in a hospital-like setting at my HMO and I don’t see how the setting should make a difference in the caring attitude of these service workers.

At the same time I can see how a socialist economic system would have made the care even better. The biggest factor would be not worrying about the bill for treatment—even if you are “only” paying 20 percent with a $500 deductible, that still adds up to a lot of money, money that most people can ill afford to spend.

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