John Geyman on Corporate Power Oligarchy and The Health Care System

For most of his life, Dr. John Geyman has been a practicing family doctor.

Dr. John Geyman

He retired 25 years ago to write books on how corporations have taken over the medical establishment.

In recent years, he has been writing about the growing power of increasingly monopolistic corporations. 

He advocates for a single payer national health insurance system that would replace private health insurance.

But Geyman says that insurance companies are now being joined by a new set of corporate middlemen asserting control over American care. 

Geyman quotes Dr. Don Berwick, former administrator of the Centers for Medicare and Medicaid Services.

“The commoditization, commercialization, the role of changing ownership to private hands, and the proletarianization of the healthcare workforce lie at the core of at least some of the reasons why this system is so deeply underperforming,” Berwick says. “You cannot find a sector in healthcare in which greed is not just manifest, but I would claim even dominant.”

“Greed right now effectively concentrates wealth in the United States; wealth concentrates political power and influence through the role of lobbying and political contribution, and that political contribution stops efforts to reign in or place constraint on greed,” Berwick said.

Your new  book is titled Corporate Power and Oligarchy: How Our Democracy Can Prevail Over Authoritarianism and Fascism. 

We just interviewed Rocky Anderson, the former mayor of Salt Lake City. And he has a similar view. He understands the corporate control and corruption of the healthcare system. And he understands that both parties are controlled by corporate power.

But you and Rocky Anderson both come down saying that this election is a choice between democracy and authoritarianism  and fascism. And Mark Green has a new book just out titled The Inflection Election: Democracy or Fascism in 2024?

On the issue closest to your heart, single payer, both parties are against it. President Biden famously said that if single payer came to his desk he would veto it.

“Biden is mistaken,” Geyman told Corporate Crime Reporter in an interview last week. “His background in Delaware may be part of his problem there. If it’s going to be Biden versus Trump, the Democrats are on the right side. And the Republicans would build a dictatorship. Already big corporate money is much further along in aiding the GOP. The rule of law will be down the tubes with Trump. Deregulation would move forward. Big business would control much of the government. We wouldn’t see much reform at all. The democratic state would go down the tubes.”

“On the other hand, if the Democrats can win the House, Senate and Presidency, then we would have a chance. Biden is still a much better President than Trump. If he wins, democracy will still be alive. We will have fair elections. Antitrust enforcement is moving forward under Biden. Small businesses would grow. A multicultural society would be possible – not under Trump. The Supreme Court finally will get reformed. And the American dream will again become possible.” 

What have the Democrats done under Biden to pursue a single payer system?

“They have to move from where they are, no question about that. The focus has to be on the downsides of Medicare Advantage, which should be called Medicare Disadvantage. Over 50 percent of Medicare enrollees are now in these private plans. And what that does is it raises the costs, decreases staff, worsens care and rips off patients. Same with Medicaid.” 

You were a practicing family medicine doctor. What has been the trajectory of family medicine practice over the last ten years as corporations consolidate control over the system?

“Fewer young people want to go into medicine now. Those that do want to go into the higher paying specialties.” 

“The whole service ethic in health care is being eroded. Around where I live here in Washington state, big corporate chains were coming in and buying up all the nursing homes around us.” 

My local family doctor still runs a successful practice with a couple of nurses and a couple of administrative staff. It’s still possible to do it. Are there still family doctors where you live operating that way?

“Yes. In fact, my physician is a solo practitioner. He used to practice in Maine and he moved here two or three years ago. He has that kind of a practice that your doctor has. He enjoys practice much more than he did when he was in the corporate system. I pay him $1500 a year for complete care.” 

There are those kinds of practices still around. Is that a rare thing?

“Unfortunately, it’s still unusual. It should not be but it is still. We have a long way to go yet within the medical profession. The system is so far off track now. It should become easier to reform when we get a real democratic Congress and president.”

Again, going back to Biden, he has said that he would veto any single payer legislation that came to his desk. He’s not a fan of single payer.

“I realize that. But let’s look at where the single payer movement is now. Harken back to David Himmelstein and Steffie Woolhandler. They were internists at Harvard. They helped create a group called Physicians for a National Health Program. That was in 1987. 

They now look at the corporate ownership of hospitals. Seventy percent of doctors are now hired by hospitals. 

That’s where the control is. And more and more hospitals are in big chains. And we haven’t even dealt with that yet. And they are now advocating for community ownership of the hospitals and health care system.”

They wrote an article for The Nation in March 2022 titled – Medicare for All is Not Enough. And they advocate for a VA for All type system – public ownership of the healthcare system. And much of the leadership in the single payer movement –  people like Margaret Flowers – are moving toward a UK style, VA style public health care system. The doctors would be government employees. How do you come down on that?

“That wouldn’t bother me a bit, as long as I had free clinical reign over my practice.” 

In the article in The Nation, Himmelstein and Woolhandler write this:

“We have long advocated for single-payer national health insurance. By eliminating private insurers and simplifying how providers are paid, single-payer would free up hundreds of billions of dollars now squandered annually on insurance-related bureaucracy. The savings would make it feasible to cover the uninsured and to eliminate the cost barriers that keep even insured patients from getting the care they need. And it would free patients and doctors from the narrow provider networks and other bureaucratic constraints imposed by insurance middlemen. We still urgently need this reform.”

“However, the accelerating corporate transformation of US health care delivery complicates this vision. In the past, most doctors were self-employed, free-standing hospitals were the norm, and for-profit ownership of facilities was the exception. Single-payer proposals hence envisioned payment flowing from a universal, tax-funded insurer (like traditional Medicare) to independent clinicians, individual hospitals, and other locally controlled, nonprofit providers. This was usually the state of play when national health insurance (NHI) was achieved in other nations, such as Canada in the 1960s and ’70s – the model for single-payer reform in the United States.”

“But insurers are now being joined by a new set of corporate middlemen asserting control over American care. Amazon plans to expand Amazon Care from Seattle to 20 other cities this year, and then to all 50 states. Wall Street is buying up doctors, hospitals, and other health care institutions, distorting care to generate profit. Most doctors are employees of large organizations, and most hospitals have become subsidiaries of corporate enterprises encompassing many facilities and firms with tenuous ties to the communities they serve. Meanwhile, for-profit control of health care providers – including by private equity firms – has burgeoned, despite strong evidence that profit-seeking siphons off resources and undermines quality.”

“These sweeping changes require an expansion of the traditional single-payer vision. Reform needs to go beyond changing the way we pay for care. It also needs to change whom we pay for care. Communities, not corporations, should own our nation’s vital health care assets.”

Do you agree that the single payer system would just subsidize the corporate control of the system?

“That sounds simplistic and off base,” Geyman says. “You could still have a free choice of physician in a single payer funded profession. I wouldn’t buy that.” 

When Trump was President, the Democrats talked more about single payer. Now that Biden is in the White House, they hardly mention it. The Biden administration has been complicit in the privatization of Medicare. 

“It’s true that the Biden administration supports privatizing Medicare. And yes, the single payer movement is not active right now. It has to become more active. The student members of the American Medical Association are more active toward single payer than their elders. That’s the hope for the future.”

[For the complete q/a format Interview with John Geyman, 38 Corporate Crime Reporter 19(12), May 6, 2024, print edition only.]

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