The Corporatization of Medicine

A Conversation with Dr. John Livingston & Tea Party Bob

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How Healthcare Lost Its Soul

Recent data from Pew Research shows a disturbing trend: public confidence in medical scientists has plummeted from 40% in 2020 to just 29% in 2022. A 2021 survey by the American Board of Internal Medicine found that one in six people, including physicians, no longer trust doctors, and one in three do not trust the healthcare system. As someone with family members working in various healthcare roles, from PAs to nurses and technicians, I’ve witnessed firsthand the transformation of our medical system from a patient-centered model to a corporate machine. A recent conversation with Dr. John Livingston, a respected physician with 47 years of medical experience, shed light on how this shift has fundamentally altered healthcare delivery in Idaho and across the nation.

The Sacred Calling of Medicine

In 1892, twelve Catholic sisters crossed the desert from Salt Lake City in covered wagons to establish St. Alphonsus Hospital in Boise. They weren’t seeking profits or market share – they came with a singular mission: to heal the sick. This same spirit of service drew Dr. John Livingston to medicine, leading him through years of rigorous training at Ohio State University, double board certification in both internal medicine and general surgery, and a distinguished 18-year career in the Navy before bringing his expertise to Idaho.

“We had fun learning to be doctors,” Dr. Livingston reflected on his early years. “We worked 120 hours a week, 110 hours a week, and we had fun.” It wasn’t about the hours – it was about the privilege of learning to heal, of earning the right to be trusted with people’s lives.

This dedication to healing created deep bonds between doctors and their communities. “When I was running the trauma service, the patients I took care of – months later I would see at church, or at school board meetings,” Dr. Livingston explained. “I was part of the community, and they were part of the community.”

From Individual Care to Herd Medicine

Somewhere in the late seventies and early eighties, a fundamental shift began in medical education. “They shifted from a patient care model to a public health model of practicing medicine,” Dr. Livingston explained. “They went very much like the veterinarians forever. Going from what is important to the individual patient to a herd model where what’s important is the herd instead of the individual.”

This shift raises profound ethical questions. As Dr. Livingston posed, “If I’m a COVID patient laying in a hospital bed dying, is it more efficacious for the public good for my doctor to let me die and take care of other patients? Or does my doctor have a professional and ethical duty to put me above everything else, including the cost of care and all that entails?”

The implications go far beyond treatment decisions. Today’s medical students are being trained in this public health model, where individual patient outcomes are secondary to population statistics. “Patients understand this,” Dr. Livingston noted. “Patients understand that they’re not being looked at as individuals but as a big group. It’s a medical form of tribalism.”

The Rise of Corporate Medicine

The transformation accelerated between 2002 and 2004, when legislative changes in Idaho opened the door for hospitals to absorb medical practices and employ physicians directly. Dr. Livingston watched this transformation from his position as head of the Legislative Review Committee at the Idaho Medical Association, seeing how seemingly technical changes in law and regulation gradually shifted power from healers to administrators.

The hospitals that were once focused solely on patient care became complex business enterprises. “Saint Luke’s is now a hospital, a real estate company, a bank, and an insurance company completely vertically integrated,” Dr. Livingston explained. “Four of its five biggest businesses have nothing to do with taking care of patients whatsoever.”

The Death of Critical Thinking in Medicine

Perhaps the most insidious effect of corporatization has been the replacement of physician judgment with standardized protocols and clinical guidelines. These guidelines, often created by administrators who have never treated patients, come with a powerful enforcement mechanism called money.

“In order to receive payments from Medicare, Medicaid, Tricare, and now with the third-party carriers in the private sector, you had to agree to practice medicine in a certain way,” Dr. Livingston explained. “This certain way was called clinical guidelines.”

The impact on medical innovation and physician autonomy has been devastating. Doctors are no longer free to use their training and experience to find the best solution for each patient. Instead, they must follow prescribed protocols or risk losing their ability to practice. This standardization strips medicine of one of its most crucial elements: the ability to innovate and adapt treatment to individual patient needs.

Dr. Livingston illustrated this through his wife’s experience with breast cancer. When she sought treatment, the protocols called for aggressive chemotherapy for a stage one tumor – a recommendation that seemed excessive based on clinical judgment. They had to seek multiple opinions to find more appropriate care, highlighting how standardized protocols can override medical judgment.

When Healing Becomes a Business Metric

The impact of corporatization goes far beyond treatment protocols. Today, many emergency rooms and specialty care areas are staffed by temporary physicians who don’t even live in Idaho. The continuity of care – the relationship between healer and patient – has been sacrificed for corporate efficiency.

This disconnect reaches its most poignant expression in a recent encounter Dr. Livingston shared. A physician colleague, on a Monday morning, broke down in tears before his first patient, saying “I hate my job.” This wasn’t just job dissatisfaction – it was the anguish of someone who had devoted their life to healing only to find themselves reduced to meeting corporate metrics.

The COVID-19 Watershed Moment

The pandemic starkly exposed how protocol-driven medicine can suppress physician judgment. Doctors who wanted to try alternative treatments based on their clinical experience found themselves facing professional persecution. Dr. Livingston pointed to the case of a colleague at Eastern Virginia Medical School who ran the ICU and wanted to use hydroxychloroquine and ivermectin. “He was kicked off the staff, and his medical license was suspended temporarily.”

This wasn’t just about treatment choices – it revealed how completely the system had shifted from trusting physician judgment to enforcing standardized protocols. “If you don’t prescribe the way they say… you won’t get paid, and if you’re a doctor working at Saint Luke’s and you fall away from these clinical guidelines, you’ll be ostracized, and you may lose your job,” Dr. Livingston explained.

The Financial Web: Following the Money

The financial structure of modern healthcare actively works against the healing mission. Through complex billing practices, hospitals can charge both a professional fee and a facility fee when billing for employed physicians’ services – effectively doubling their revenue compared to independent practitioners. This financial pressure has forced many independent physicians into hospital employment, despite their preference for autonomy.

The complexity of medical pricing reveals a system that has lost its way. In one example, a single piece of medical equipment that cost $200 from the manufacturer ended up costing patients $4,000 after passing through various middlemen. These aren’t just numbers – they represent barriers between patients and the care they need.

Beyond IRS Form 990: The Need for Real Transparency

The current system of oversight, centered on IRS Form 990 filings for nonprofit hospitals, barely scratches the surface of healthcare’s financial reality. “It takes a forensic audit,” Dr. Livingston emphasized, to understand the complex web of rebates, kickbacks, and billing practices that drive up healthcare costs while obscuring who really benefits.

But this isn’t just about financial transparency – it’s about restoring the fundamental mission of healthcare. When Dr. Livingston spoke about those Catholic sisters who founded St. Alphonsus, he noted that “nothing in their minds was about this large business model that’s now being deployed by their predecessors.”

The Path Forward

The future of healthcare must reconnect with its past. While new technologies like artificial intelligence and telemedicine offer promising advances, Dr. Livingston cautions that they should augment rather than replace the human element of medicine. The core of healing remains the relationship between healer and patient – everything else should serve that sacred trust.

Recent appointments of reform-minded leaders like Jay Bhattacharya at NIH and Martin Kulldorff at CDC suggest potential for positive change. But real reform requires more than new leadership – it demands a fundamental rethinking of what healthcare should be. It requires returning to a model where doctors are free to think critically, innovate, and truly serve their patients’ individual needs.

The transformation of healthcare from a healing profession to a corporate enterprise hasn’t just compromised efficiency or economics – it’s damaged the very soul of medicine. The path forward requires not just policy changes, but a return to the fundamental mission that brought those Catholic sisters across the desert in covered wagons: the calling to heal.

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