Patients or profit? with John McDonough

Neoliberalism, characterized by free-market fundamentalism, has fundamentally reshaped the U.S. healthcare system since the late 1970s, driving significant consolidation and financialization. This shift, rooted in Milton Friedman’s doctrine of maximizing shareholder value, redirected corporate focus from patient care to profit extraction. Federal antitrust policy underwent a quiet but transformative change in the 1980s, shifting from preventing monopolies to encouraging consolidation, which now leaves over 90% of hospital markets heavily concentrated. Furthermore, the aggressive entry of private equity into patient-facing services—from physician practices to nursing homes—has prioritized investor returns over clinical outcomes, often resulting in higher costs and reduced service quality. While recent administrative shifts signal a potential departure from these long-standing neoliberal norms, the long-term trajectory of American healthcare remains uncertain as the system navigates the tension between market-driven financial incentives and the fundamental duty of care.