Could healthcare benefit from more leaders in the spirit of Dr. Martin Luther King Jr.?
The term ethical erosion is used to describe the “gradual decline of values, beliefs, and truths.”
I first encountered this term in medical school to describe the loss of sensitivity and care as students progressed from their first year of medical school to the end of their training.
Incoming medical students apparently have pure values.
As they write on their medical school applications, they express that they want to “help people.”
But at the end of their training, they sometimes find themselves hardened and less empathetic than they once were.
The medical student who once hugged his suffering patient may not be able to make eye contact with a patient or return a phone call later in his career.
Simply put, their ethics have changed – or eroded.
This Martin Luther King Jr. Day, I woke up wondering about the ethical erosion as it pertains to people who work on the business side of health care.
Many (like me) who go to work on the business side of healthcare do so because we believe we can contribute meaningfully to society by leading a good life.
But years into our careers – after being socialized into the industry – something changes.
We no longer struggle with the authenticity of our corporate pablum.
We stop worrying if the products and services we sell are bankrupting people and society.
We stop struggling with the human impact of our decisions.
Abnormal behaviors and practices begin to feel normal.
The reality of keeping a job or keeping a company alive supersedes any prior personal ethics.
Making living part of the equation completely destroys the notion of social contributions.
“I have a child to send to college.”
“I have a boss who needs a result.”
“I have shareholders who expect a return.”
When pushed for some obviously objectionable aspect of our business (prices, access failures, denial rates, health care disparities as examples), we fall back on the “broken system” explanation.
We can say, “We’re just doing the best we can with the incentives or constraints we have.”
Or we can engage in deviance:
Pharmaceutical executive blames health plan.
Health plan executive blames doctors.
Doctors blame the government.
And so on and so forth.
The broken system explanation is easy to accept at face value because, well, it’s true.
The system is broken and the cracks are too numerous to count.
But explaining the broken system is also a distraction.
A distraction that often achieves the intended effect.
It takes the heat off anyone who is under the microscope at the moment.
It helps avoid close scrutiny of its own practices and enables the status quo.
It reflects a deep, false, numb impotence that is the ultimate conclusion of ethical erosion.
A pharmaceutical company whose drug is already expensive can commit to not raising the price of its drug more than inflation.
But more often than not, they don’t.
The insurance company that creates friction by denying claims that they will ultimately approve may approve the claim more quickly.
But more often than not, they don’t.
The for-profit health system that aggressively charges patients with debt they will never collect can commit to not destroying the credit of their sick and poor patients.
But more often than not, they don’t.
No rule changes are required to implement any of these small but significant improvements to our broken status quo.
There are no changes in the regulatory landscape.
No “massive” system rework.
No major changes in financial model or accounting practices.
No, it just requires a stronger ethical framework.
A deep belief that everything doesn’t have to be the way it is.
A burning desire in your gut to be better.
Which brings us to the issue of the ethical erosion of healthcare leadership and what it means to be a healthcare leader at any level in an organization in 2025.
I attend many meetings and conferences with health leaders where there is a lot of admiration for the problems.
And I am guilty of being one of these admirers.
There is much debate about the underlying causes. And possible solutions.
But when it comes time to take action – even small action – we are again faced with deep, false, numb helplessness.
“I can’t do anything.”
“My board won’t let me.”
“The expectations of my shareholders will not allow it.”
“We need a legislative fix.”
Some of which are true, but many of which are not.
And so we go to more conferences and talk. And we write articles (like this one). And it boils down to the idea that we are making a difference through dialogue.
Or, more ominously, we remain silent. Oh, we are silent.
A kind of quiet feeling of misplaced resignation.
(cricket)
If people who work on the business side of health care were more firmly (and loudly) anchored in the simple ethos that drew us to health care in the first place—”I want to contribute to society”— we can begin to see ourselves less as powerless, hopeless objects of the system and instead as leaders of the system.
We can stop always believing that change has to come from the outside and instead begin to believe again that it can come from within.
And we can begin to rebuild the trust that we have lost and continue to lose.
We can begin to hold the title “leader” in the classical sense of the word – as Dr. King – and do the right thing even when it gets in the way of our picayune interests.
Just as the physician who is no longer compassionate or caring toward his patients should no longer be a physician—perhaps hopeless, powerless, resigned, and, worst of all, silent, the healthcare leader who no longer feels change it is his or her responsibility and the personal mandate should go away.
Because better, more proactive, more vocal and self-reliant industry leadership will be as important as anything to giving an angry and disaffected public the kind of health care it needs and desperately deserves.
