# The Progression of Medical Decision-Making and the Role of Profit and Politics in Health Care
Throughout much of contemporary history, doctors occupied a paternalistic role in medical decision-making. Patients placed their complete confidence in physicians, trusting that their expertise would lead to the best outcomes. However, by the 1970s, medical ethicists started promoting a transition to shared decision-making, granting patients a more proactive role in their health care. Although this approach has achieved considerable acceptance, research reveals that over half of patients would rather have their doctors make medical decisions for them. Furthermore, more than 80 percent of individuals face difficulties in making rational healthcare choices due to emotional or informational barriers.
Despite the aspirational move towards shared decision-making, the realities of present-day healthcare create challenges in its implementation. Physicians are presently overwhelmed with administrative responsibilities, which diminishes the time available for them to educate and encourage patients to take an informed role in their treatment. While health educators could help close this gap, patients need to be open to new information, question established beliefs, and evaluate medical recommendations impartially. This process can be challenging as personal hopes and expectations often cloud rational decision-making.
## The Commercialization of Health Care
One of the most critical changes in recent years has been the conversion of healthcare from a profession centered on patient welfare into a profit-driven business. More and more, medical institutions and private practices are acquired by for-profit organizations that emphasize financial gain over patient care. Executives within these corporate healthcare settings tend to focus on revenue growth, often at the cost of patient safety and sufficient care.
Research illustrates concerning trends within profit-oriented healthcare models. Following acquisitions of hospitals by for-profit organizations, staffing levels and wages are often cut to reduce expenses, potentially jeopardizing patient care. Likewise, as physician practices shift to for-profit operations, service costs generally increase while the length of patient visits shortens—resulting in diminished quality and less individualized care.
The Medicare Advantage insurance marketplace highlights the pursuit of enhanced profits at the cost of fair medical practice. In 2024, one company announced an astounding 52 percent profit increase while concurrently requesting greater government reimbursement, citing poor earnings. Another insurer incentivized physicians with financial bonuses for assigning patients additional diagnoses, not for necessary treatment but merely to classify them as “complex cases”—a label that leads to increased government funding.
## Prior Authorization and Financial Hurdles to Care
One of the most debated aspects of healthcare cost management is the prior authorization (PA) process. Initially designed as a Medicare strategy to ensure that treatments conformed with best practices and to manage rising expenses, prior authorizations are now often misused by insurance companies to control payments and maximize profit.
Certain for-profit hospitals have taken the extraordinary step of mandating prepayment for surgical procedures, even when patients have valid insurance coverage. In extreme situations, hospitals may deny discharge to patients until full payment is made or a written guarantee from an insurer is provided. Such practices raise ethical questions regarding the accessibility of urgent medical care and could set a perilous precedent: will financial credit scores soon dictate who can receive emergency medical treatment?
## The Politicization of Medicine
The impact of politics on medical decision-making has become increasingly conspicuous in recent years, with legislation at both state and federal levels influencing medical practice more in line with ideology than scientific consensus. Several proposed and enacted laws disregard established medical knowledge, contradict the majority preferences of constituents, and place physicians in ethically fraught situations.
A notable instance is the surge of six-week fetal heartbeat laws. These regulations have been challenged on scientific bases, as embryological development indicates a fully developed heart does not exist at this six-week juncture. The so-called “heartbeat” detected at this time is merely a collection of electrical activity rather than a fully functioning circulatory system. Despite this, such laws have been utilized to limit reproductive health services.
In Florida, poorly constructed legislation targeting gender-affirming care resulted in vague language that risked legal consequences for surgeons performing life-saving procedures like mastectomies and prostatectomies for cancer. Similarly, Ohio lawmakers enacted a law permitting hospitalized COVID-19 patients to demand Ivermectin treatment—an unproven remedy—while imposing legal threats on those who failed to comply, though it remained unclear who would bear the consequences.
## Restrictive Policies and the Future of Health Care
The growing intertwining of medicine with political interests and financial incentives has also led to regulations that deter physicians from practicing in specific states, unintentionally decreasing access to care. Many of these laws foster uncertainty, making healthcare providers reluctant to deliver treatment due to fears of legal or professional repercussions.
Certain states have introduced policies that may dissuade vulnerable demographics from seeking medical assistance. For instance, some officials have attempted to impose requirements for hospitals to verify proof of citizenship before admitting patients, while others have demanded records of pregnant individuals who may be considering abortions. Such regulations could hinder individuals from pursuing necessary medical help, potentially