The United States is not the only nation on earth to have private entities involved in its health care. But there is a neat difference: in other nations, such as the socialist democracies of Europe, these companies are forbidden by law to make profits. In the good old U.S.A. however, where capitalism has become a religion and Mammon its god, it is perfectly acceptable for players in our so-called “health care system” to wring every cent it can out of patients – and let those who cannot pay or fall through the cracks to suffer and even die. And even if these institutions deign to offer treatment, they punish them by driving them into bankruptcy. A 2009 Harvard study reported that nearly half of all bankruptcy filings were due to medical costs – up from only 8% in 1981 (and those of us who were around remember what happened that year).

It’s worse than you think.  According to an article in the current issue of Health Care Affairs, there are no fewer than fifty hospitals that put a 1000% mark-up on health care services and products for uninsured patients. These are not fancy, boutique-style clinics that offer elective procedures, deluxe private rooms and fancy gourmet meals, catering to the well-heeled. These are hospitals in communities where people can least afford it.

According to the authors of the study, “Extreme Markup: The Fifty US Hospitals With The Highest Charge-To-Cost Ratios,” forty-nine of these hospitals are for-profit entities (no surprise, there), and forty-six of those are owned by large companies.  Thirty-nine of these hospitals are under control of just two corporations: Community Health Systems Inc. (CHS), and the infamous Hospital Corporation of America (HCA).

Some may recall that the latter was under federal investigation for fraud in the late 1990s, forcing its chairman at the time to resign. Eventually, HCA admitted to defrauding Medicare and other programs by inflating diagnoses, filing false reports and paying kickbacks to physicians. And of course, in the great American tradition of “failing upward,” that chairman – Rick Scott – went on to become governor of Florida, an office he currently holds.

The HCA wound up settling the charges for $2 billion, the largest such settlement in U.S. history. But apparently, that hasn’t done much to change their behavior. HCA facilities, along with the others, are still charging ten (and in a few cases, over twelve) times the rates allowed by Medicare.

Of course, like natural humans, “corporate people” are always concerned about their precious image. Both CHS and HCA issued statements, letting the public know that they offer “discounts” to uninsured and out-of-network patients. It doesn’t change the fact that, like virtually every other sector of the unbridled American “free market,” these corporations are putting profits over people, and are going to maximize those profits as much as they can – human costs be damned.

Part of the fault lies with government policy. While the Affordable Care Act was a huge step in the right direction and has allowed millions to access health care for the first time, it falls short in a number of ways. The ACA requires that hospitals charge no more to uninsured patients than they do commercial health insurers. Unfortunately, this regulation applies only to non-profit hospitals.  When it comes to the for-profit facilities, uninsured patients or those who have the unmitigated gall to be “out-of-network” are at the mercy of the corporation (almost an oxymoron, there).

This is symptomatic of a deeply-rooted disease known as “for-profit medicine” – something  unknown and illegal in every other industrialized nation on the planet. It is an established fact that Americans pay some of the highest health care costs in the world, yet according to a 2014 report from The Commonwealth Fund, the United States ranks dead last among eleven of the richest countries – all of which offer guaranteed, publicly-funded health care as a right of citizenship – in outcomes.


K.J. McElrath is a former history and social studies teacher who has long maintained a keen interest in legal and social issues. In addition to writing for The Ring of Fire, he is the author of two published novels: Tamanous Cooley, a darkly comic environmental twist on Dante's Inferno, and The Missionary's Wife, a story of the conflict between human nature and fundamentalist religious dogma. When not engaged in journalistic or literary pursuits, K.J. works as an entertainer and film composer.