The profit-obsessed monster destroying American emergency rooms
vox.com
vox.com
There’s a variety of weird examples of this mixed system:
>Poor people use ERs for every day healthcare, usually they get away with paying nothing, no insurance
>Working people with insurance pay more to enable this access for the destitute (or criminal) portion of the population
>Old people are sort of entitled to free healthcare. They get medicare, but if they want everything, they have to pay for “supplements.”
>Young people pay for the old people’s healthcare twice, on their payroll taxes and in the form of higher premiums. A 25 year old male should absolutely not have a $300/mo health premium. But he does, because his premium is paying for other’s care.
This is a system pretending to be private, but it’s actually just inefficiently public. It would be more efficient to pay for it using taxes, both income and sales taxes, rather than letting some groups—the poor and the elderly—off the hook arbitrarily.
Alternatively, abolish health insurance altogether—a notoriously inefficient and exploitative industry that does not suit the classic purpose of insurance (boat accidents and fires)—and see what happens. This is obviously a rather unpalatable option due to the chaos that would ensue, but it’s probably the best option.
I don't think this is true. Some countries with public healthcare are far more efficient than our system.
But there are countries that have systems similar to ours that are far more efficient as well.
We just have a really shitty system, and who pays for it isn't going to change that. It's a hard technocratic problem that doesn't have any easy answers. (Besides increasing the number of residency slots, removing the bachelor degree requirements and allowing foreign physicians to practice which are basically freebies.)
Really? Which ones are they?
Israel also has a public healthcare system in practice. Mandatory participation in 1 of 4 non profit insurance programs looks like private insurance but … https://en.wikipedia.org/wiki/Healthcare_in_Israel For the health tax, wage-earners and the self-employed must pay 3.1% of their monthly salary up to 60% of the average prevailing market wage (appx. NIS 6,300 in 2020), and 5% of anything earned above it.[25] Employers are legally obligated to deduct insurance contributions from their employees' salaries, while the self-employed must arrange payment on their own. Pensioners have contributions deducted from their pensions, as do those receiving unemployment benefits. Those who are not working but have income must pay 5% of their income in health tax, while those who are not working and have no income must pay NIS 104 a month.
Switzerland has a similar system with mandatory participation and non profit insurance programs. https://en.wikipedia.org/wiki/Healthcare_in_Switzerland
There’s other factors like our obesity rate, but we’re basically intentionally shooting ourselves in the foot when it comes to healthcare costs because cost savings is lost profits for someone else.
Medicare for everyone seems like an "easy" fix but we have too many red state neanderthals in the US who oppose policies that clearly benefit them claiming "personal responsibility" though they oddly still think schools, police, fire departments, etc. are just fine...
Are you able to point to a completely private system that is insurance based and works well?
Or what do you think public systems that also include private insurance add to the table that is missing from the US market?
Medications also don't cost more or less based on population size. Although in a single-player market monopoly, I suspect a larger country should have greater cost negotiation power, so this should actually benefit a larger country like the U.S.
A greater factor than population size may be demographics. Countries with older and less healthy citizens would have a larger cost burden.
A poorly designed government structure could also disadvantage a large country like the U.S. This has been observed in the U.K., where successive Conservative governments have centralized the healthcare system over the last two decades, reducing efficiency and increasing cost. Not sure about Switzerland, which is also a federation of states (cantons).
Then there's the other big problem. Base insurance, which btw goes up to €150 / month next year (per adult), only covers cheap generics whose purchase prices are negotiated by the government (or something like that). The consequence now is that the manufacturers are not willing to pay the import fees for their generics, because the profit margins are too slim. Thousands of types of medications are now no longer available, difficult to get, or will only be available again in X months. This is stuff like basic painkillers, adhd, diabetes, etc.
The system is failing, is all I'm saying.
Totally unlike the US's private insurance in every way that matters.
> non-profit private insurance
Only base/minimum coverage, the same companies still offer extended/supplemental plans with no such limitations.
Also is the for profit part really that important? Profit margins are capped and even if all insurance companies became non profit and costs went down went down by another 5-10% or so at most, would that fundamentally change anything? The extreme inefficiency seems like a mich bigger issue.
Typically, those countries have BOTH a public system and a private sector. This means the private sector actually has to be really competitive, because they're competing with "free" (or close to it). This isn't the case in the US, there's no competition.
Urgent Care & Emergency Room combos are here on every corner. It’s a lucrative business, so it makes sense that private equity firms are gobbling it up. But I think the more interesting problem here is one level up. Why are there so many of them? I see two possible reasons:
1. Anytime one of my family members gets sick, it’s rather hard to make an appointment with the primary care provider. They are usually booked, and it takes a day or two to get in.
2. Bills from the primary care providers tend to be significantly higher than a bill from urgent care. Anytime I go to a doctor, it’s around $300 for a basic consultation visit. Any problem easily adds $50-100 to it. My typical bill from an urgent care visit for sickness is around $150.
Both places are in-network. Anyway, that’s my experience.
Do you have one of those high-deductible plans designed to discourage people from seeking any healthcare?
Totally agree it should be available for cash pay.
But frankly, even if you are spending the money on medical expenses in the same year, you're also getting a lot of benefit out of spending pre-tax rather than post-tax money.
Post-ACA, high-deductible and HSA-compatible are not the same thing anymore. In my state, for example, there are no longer any HSA-compatible insurance plans but there are several high deductible ones.
If you require care for chronic medical issues, that often not even one treatment. So, the annual numbers might work out, but you're still left with a massive cash-flow issue at the beginning of every year (because there hasn't been time to fund the HSA, you have to float the deductible + co-pays/% up to your max OOP).
And that's assuming your income supports the max HSA contribution in the first place. Maybe after a few years, it balances out a bit, if you're lucky.
This is in fact not the purpose of those plans.
They try to actually be insurance (ie, in case of unexpected high expenses) rather than a combination of insurance plus pre-payment of typical expenses.
1. they do (post-ACA) function as effective bankruptcy insurance
2. they likely deter the people enrolled to avoid early/minor/preventive medical visits.
In other words they are actually insurance. Not a prepaid healthcare plan. No one should be using “insurance” to cover every day expected expenses like random doctor visits for the flu.
They are a small fight against the massive principal agent problem which is the sole issue anyone should be focusing on if they care about healthcare costs.
The inhabitants of just about developed industrial/post-industrial society other than the USA seek to differ.
If it was like $20, sure, but when a "routine doctor visit" costs $300 I'd rather use insurance than deal with the mental load of deciding if it's worth the money. I wonder how many people develop more serious conditions because their high deductible tips the calculus towards avoiding the doctor.
The $300+ bill usually gets adjusted to about 50% by the insurance (I’m in network), and then I pay my share, depending on the state of my deductible and out-of-pocket expenses. (So in my case, 90% before deductible is met, then 10%, until I reach my OOP max.)
UC bill is processed in a similar fashion, and my actual responsibility tends to be less than from my primary care doctor.
Told my primary care at my next appointment and she basically said she'd have done the exact same thing.
The next "one level up" might explore how much is because the community is quite morbid and unwell, because modern culture has displaced traditional home/self care with consumerized services, or because of other things.
There are people I know who are largely healthy and who consult paid medical services many times per year for everyday disturbances, and others who take decades to overcome procrastination to even get a physical. The demand for commercialized health services is very much a cultural thing, especially for everyday wellness, and that culture has been evolving quite dramatically.
Meanwhile, there's no ignoring that obesity and sedentary living are rampant, that a recent pandemic spooked people about infectious disease and its possible consequences, etc.
You're thinking about the pocketbook economics, here, but looking at it through these other lenses might provide further perspective too.
Not sure what you mean by this? If I have a broken bone, I'm not going to set it myself at home and take a few aspirin. Same if I'm puking my guts out.
If you just mean getting exercise and eating healthy then I fully agree with you. But, when you're actually sick, and need to see a professional, that is the right time for "consumerized services".
For some, this is rooted in a confidence in their own personal-community care, for others its an insight into what few actions a doctor might take themselves for these issues, etc
There's lots of ways to explain it, and certainly many of them can be easily criticized by people who see professionalized medicine differently, but you may as well let go of the idea that everybody out there approaches it in the same way that you do. It's probably not even all that consistent among your own circle of family, friends, and acquaintences.
We're still only in the beginning of what seems to be a sweeping cultural transformation around how people see health and medicine and the perspectives people bring are still quite diverse.
At the same time, the overall direction in recent decades is definitely towards seeking commercial medical care for more concerns as well asserting that this is an entitlement that all people should have access to.
Maybe give us an example of some people who do this?
Consider two non-professional runners who develop a stress fracture. It's a fairly common injury for distance runners who push themselves too far. It presents as a certain kind of pain and that pain becomes aggravated under certain conditions. It's generally easy to self-diagnosis, and more serious fractures are generally evident because they're far more disabling and intensely painful.
One goes to a doctor, who quickly has a strong guess as to the problem. Nonetheless, they send the runner for an x-ray to confirm, then take another appointment to review the results and prescribe a treatment. That treatment will amount to rest and patience, and (with some doctors) some prescription for the pain. Total cost billed to someone is probably on the order of $1000.
The other is pretty confident in their self-diagnosis and can't fathom the time demands, financial cost, and social resource consumption of bringing in a industrial apparatus just to confirm that diagnosis and be told to take it easy on their affected leg for a few months.
Both examples play out everyday, and there's essentially no difference in health outcome for the vastly most common case. It's true that the latter is at higher risk of missing a more serious complication, but it's also true that the former invites costs, consequences, and risks of their own.
A friend did the same but got a doctor scan; they confirmed it was broke but did nothing else.
I cannot just schedule an appointment for 3 days ahead because “late” cancellation costs $$ too.
TLDR; it isn't at all surprising to me that yet another vulture on American health care expenditure has discovered how profitable emergency rooms can be and that we see such a mad proliferation of urgent care facilities on every corner.
But if you come in during UC hours and the procedures are outside of UC, you can still end up being billed as an ER customer. The difference is usually in thousands.
People end up getting worse and cost the system more, so the cycle continues.
Regulation is a tool that can be used for many ends. It's not very helpful to speak about them collectively.
For example
All doctors require 1 year of schooling 2 year 5 years 10 years 20 years.
Each is 1 law but has each also has very different level of burdensomeness.
It’s interesting that the one specific thing you mention is insurance. That particular complexity doesn’t come from regulation. It comes from the immoral insurance industry.
We'd see far more reasonable pricing, and much less need for something like medical insurance, without the regulations that artificially limit the supply of practitioners and clinics, that prevent competition, and that introduce unnecessary costs, among other distortions.
It suggests regulatory capture and/or lack of proper governmental oversight.
"Lack of government oversight" almost never leads to high consumer prices. It can lead to externalities, but if there are no regulations preventing anyone else from competing with the incumbents, it's very hard to sustain monopoly rents.
Lack of government oversight and regulations almost always leads, eventually, to cartel pricing and/or monopolistic type pricing.
Regulations as a concept are the category of thing which is causing the problem. You then have to look into which specific regulations are contributing to the problem, but there are 10,000 of them. You can name some of them, like Certificate of Need laws, but that's just a representative example rather than an exhaustive list of every problematic regulation. So people say "regulations" or "inefficient regulations" because what else are they supposed to call them?
Hardly anybody thinks the ban on leaded gasoline is a bad regulation.
> Lack of government oversight and regulations almost always leads, eventually, to cartel pricing and/or monopolistic type pricing.
Only if you're specifically talking about lack of antitrust regulations, which is the exception rather than the rule in the overall category of regulations.
Most regulations simply increase costs. This is true whether they're good or bad. The ban on leaded gasoline increases the price of gasoline; lead is a cheaper stabilizer than what they use now. The ban on circumventing DRM increases the price of playback devices (or reduces quality at the same price); device makers have to pay to license the stupid DRM and it impairs competition by preventing anyone from making a device with features Hollywood doesn't like. But the ban on leaded gasoline is a good regulation because it's preventing a major externality, whereas the ban on circumventing DRM is a bad regulation because it doesn't do what it was sold as doing and instead is used by the studios to capture the market for playback devices.
Getting rid of bad regulations improves efficiency and lowers prices.
Regulations as a concept are the category of thing which is causing the problem.
No sensible person thinks regulations as a concept is bad but, well, roughly 1/3 of the U.S. population is not sensible on this topic. No sensible person thinks all regulations are good. Regulation is not the thing to talk about since the issue isn't regulation but bad governance and oversight. The issue is politicians in the pockets of insurance companies. The issue is that we live in a country where profit is the holy of holies that must not be messed with.
The number of people who think that all regulations are bad is limited to a handful of actual anarchists with no real power and a presumably larger number of rules pedants who want to play different definitional games where they use "regulations" to refer to the things they don't like and call the things that they do like "laws" or "rights" or some other allegedly distinct thing where the distinguishing criteria is doing all the work.
Of course, getting people to spend all day arguing about terms is to the advantage of the people who like the status quo, because then they can get the people who claim regulation is generally good to pass their regulatory capture rules and get the people who claim regulation is generally bad to repeal or fail to enforce the e.g. antitrust rules intended to protect people from their predatory behavior. But then you're just playing into their game -- the Certificate of Need laws etc. are of the first category.
The healthcare is good if you got something well defined and urgent like a hearth attack or cancer (but less good than cancer treatment in the US). But if you got something less urgent then you are kind of screwed.
Medicare costs do not look like the rest of the world. Medicare has slightly lower costs than private insurance but that's mostly bargaining power not any increases in efficiency. They free ride a little off money made off private insurance.
I'm more familiar with Canada's taxpayer-funded, "universal" provincial health care systems than the European ones, so I'll describe the costs we typically see with them.
Government health care spending makes up a huge portion of the provincial budgets each year. This results in costs like high tax rates, and significant government debt. (Those, in turn, introduce other costs, such as the stifling of business development and employment, among others.)
Another significant cost is the poor quality of service. Long delays are the norm. This can mean single-digit hours-long waits for emergency service, double-digit hours-long waits for semi-emergency situations, and weeks to months for routine diagnostics and specialist appointments.
A lot of Canadians don't have a family doctor, and walk-in clinics are typically quite busy and have relatively short hours, so people end up going to emergency rooms even for relatively minor health issues. That only exacerbates the problems there.
Even once you're finally seen by a practitioner, there is little incentive for them to do a good job because there's pretty much no competition, and no punishment for providing poor service. Don't expect a favourable outcome, especially for anything requiring in-depth investigation or long-term treatment.
Common dental, vision, and pharmaceutical costs often aren't covered by the provincial systems, which results in many Canadians paying even more money for costly private medical coverage on top of the "universal" coverage they've already paid for via taxation and public debt.
It's very revealing that despite paying a lot for the local health care systems, Canadians with the means to do so will often seek treatment in the US anyways. Even if they have to travel and pay a lot more money to do that, at least it tends to result in much faster, and much higher quality, service than they would ever have received in Canada.
To be clear, the "artificial inefficiencies" here include treating poor people, treating elderly people, and treating people regardless of their conditions.
The alternative, which we have lived, is those people just dying. We, as a collective society, decided these features are "non-negotiable". Hence, the US has a semi-socialized system in the form of insurance.
The reason your premiums are so high is because some homeless man somewhere is getting Narcan as we speak. Your woes of a communist future have come to fruition, but it has been packaged in such a way that the average American does not realize it. We have the worst of both worlds - the sheer greed of the private sector, with the burdens of a public policy.
If we seek efficiency, as you say, the answer is obvious. Abolish insurance, and provide single-payer healthcare. Delete the middle men on top of middle men.
Considering the ACA requires insurance, it indirectly does. While there are cash-only doctors, it's very rare.
This gets mentioned every time. The regulation boogeyman always shows up. If only there were fewer rules... everyone could make more money, the little guy would be able to enter and play fast and loose, and nobody would do the wrongdoing those rules were meant to correct/prevent. Yes, there are regulations in health care. There are regulations in almost every industry, and yes, they can be a pain to deal with. Yet people still start businesses, make money, grumble endlessly about those regulations, and society marches on. As part of the general public, who are often the victims of business's negative externalities, I'm grateful that our government still manages to regulate businesses.
In the example of the individual doctor's office, perhaps the government should provide software and billing systems to adhere to their mandated processes, inspectors, fund regulatory agencies, legislative support, etc.
Otherwise regulatory capture can drive out much of the competition, potentially leaving us worse off than we could be otherwise.
Sheesh.
Doctors are medical technicians, not lawyers, and the more you bury them in (largely billing) regulations, the worse care you get and the less time with that doctor you get, and the more money you pay for worse healthcare.
One such regulation is "certificate of need" laws, where you effectively need to ask the incumbent for permission to open your would-be competitor.
I don't need prescription or doctor recommendation to get it done. I can also take my own urine/hair/swabs, walk into a lab, pay and have the requests results online in a few days.
If I need MRI I can usually schedule it for the next day in multiple private points and again the results are going to be there the same day. The price is around 200 bucks for say cervical spine.
How is it in your country? Do you know how much is required to get those basic services in other countries?
It’s not all the tests I think, but many.
Because the public option exists they can't run the prices up however they want so it's usually very competitive.
No, this gets mentioned in other healthcare conversations but rarely in PI takeover conversations.
But that's the problem, isn't it? They don't. The smaller providers actually do go out of business or get bought up by private equity and then the quality of care suffers -- which is the thing the regulations were sold as improving.
They stay in business so the model seems to be viable, but perhaps only because there are so few of them doing it.
I've worked in healthcare, and pretty much my whole family does in all the professional roles you can think of.
I have mixed feelings about this article and others like it because the motivation to strip the system of everything until profit is left is a serious problem throughout US healthcare. However, it's not unique to private equity — private regional monopolies, or even privately owned clinics and hospitals, can have a similar effect. These articles then have a way of shifting the focus away from the underlying administrative practices that result in these problems, and toward private equity per se.
The regulation problem is real too, and I can give lots of examples. It's unlike a lot of other fields too in the scope and how ingrained it is in the system. EHRs are just one example: although well-intended, they were mandated with no "organic" roll-out, and pulled what was in-house staff and services and pushed it outside into large monopolies like EPIC (who are now the subject of an antitrust lawsuit IIRC). This happens over and over with all sorts of aspects of US healthcare.
I also have problems with the focus of these types of articles — for whatever reason, they often start with or are centered around this kind of wistful new physician (or very old physician near retirement) longing for the romanticized old days where physicians were in charge and ran everything. Should that be the case though? Do we really need MDs to do and approve of everything? Aren't there things that are done as well by PAs, DNPs, and other types of providers that don't even exist yet because of how calcified the healthcare system is? Can't patients do more at home without a middleperson — e.g., needing to approve of some medication that the person has taken for decades without incident and is really truly pretty harmless in the grand scheme of things?
The problem you described is very real. It's overregulated, in ways that incentivize large monopolies, either of clinic and hospital owners, or provider rent seeking guilds, infrastructure providers, etc.
I guess I feel like these types of articles point to one type of problem, but then tend to implicitly suggest the solution is to just roll back time to some earlier era, not recognizing that that earlier era had a smaller patient population, with less regulation, less monopoly where there was no need to scrutinize whether a certain type of degree is really necessary, where there weren't huge hidden overhead costs of all these monopolies permeating down to the patient.
Fixing US healthcare is going to require a bunch of things that collectively will cause pain for a lot of entrenched players: lots of antitrust lawsuits and laws, lots of deregulation aimed at giving patients more choice and self-care options, more public payer options, lots of eliminating or restructuring licensing requirements to create more types of providers, and so forth. They don't map on easily onto current US political party platforms either.
If there were a poorly run company, private equity could use its own money to acquire it, restructure it to be more efficient and valuable, and capture cash flow while owning it and profit from taking it public again. They would make money, the economy would be improved, and a healthy new public company would build more public wealth.
This is a bit idealized, but something closer to this really did happen.
Now they use raise money from rich people and operate more as alternative investment management, take over efficient operations, strip them, use leverage in the opposite direct (acquisition targets take loans and transfer the money back to PE). We end up with worse services, unsustainable and over-leveraged businesses, money transfer from the public to the wealthy from increased welfare and bankruptcies, and a worse economy because of changes to the velocity wealth returns to the economy from private fortunes.
This stinks when it is the Office Depot or Friendly's, but it is a massive problem for residential real estate, delivery of medical care, medicine, and basic food production.
You would think that the brilliant folks at KKR, Carlysle, Blackstone, and others would read their classics and know the story of the ancien régime and Romanovs.
Private equity's job is to take a slowly failing company, extract the value, and turn it into a suddenly failed company.
See department stores in the 90s, Circuit City, ToysRUs and restaurant chains more recently.
This is a win for the former owners who get cash for their business and can blame the failure on PE, rather than admit it was on a path to fail slowly. This is a win for PE, because they can often extract enough value to make a good profit. It's a win for Spirit stores, because they get great locations like the old Circuit City that still has those maroon tiles up in 2024 and the old ToysRUs that still has the R up.
When a sector of business is being bought by PE left and right, it's a sign of unhealthy businesses and the owners want out.
The average ER wait time across DC was 5 hours and 29 minutes. That's across all hospitals.
Using more PAs and NPs seems like it could potentially be beneficial, since 1) they are cheaper than physicians (this could be attractive to patients if it lowered the bill for treatment), 2) the supply of physicians is more constrained (due to limits in med school and residency slots to avoid "oversupply", as well as longer training time), and 3) NPs and PAs may be well positioned to take care of many non-emergency patients in the ER, urgent care, non-life-threatening cases, etc. What might be helpful is a higher tier of ER-specialist NPs and PAs, as well as an adequate supply of ER physicians to treat the emergency patients in the ER who really need them.
But as the single payer, the government would have the incentive and power to address the problem systematically and deliberately.
Do not go to the ER for a runny nose or a sore throat. You have an immune system. Go to bed and let your body recover.
Take on responsibility for your own health: eat better, get to a healthy weight, exercise. If you have chronic conditions that must be managed medically, shop around, find practices that are still locally owned. They are out there.
You can try to live in a state or region that where emergent care is available that isn't owned by PE, or you can live in a country other than the US. Neither of those are a guarantee that your circumstances won't change.
I'm in the UK (NHS), I don't see a bright future for systems like the NHS or mostly private systems like the US. There's an extreme core cost which "systems" cannot make disappear.
https://en.wikipedia.org/wiki/Apparatchik
Entities like PE or conglomerates are a lot like Soviet bureaus: giant bastions of bureaucrats appointed to run things they have no direct expertise in running.
The underlying issue here is what I call the "big dumb money problem." You get entities with more resources to deploy than intelligence or expertise to deploy them efficiently.
A major argument for things like anti-trust and some degree of progressive taxation is to avoid what I call "Soviet Kapitalism" -- which the top of the economy ends up dominated by big dumb money and bureaucratic monopolies. When this happens a market economy starts looking indistinguishable from the USSR. In a way you could say a totalitarian state like the USSR is just an extreme version of this with the state acting like one giant monopoly mega-corp.
Money needs to be redistributed so the ratio of dollars to brain cells is more balanced.
It will likely do that naturally unless something gets in the way in the name of progress.
You're thinking of using money as a measure but everyone else is using it as a target...
Property taxes are different, because more services get provided to people with more property. Income taxes are fine because we take it as a given that the state has the ability to regulate every aspect of domestic financial transactions and financial lives, at least in our currency (even if we don't or shouldn't, we of course can.)
A yearly individual income cap means at the least people would have to put money in more hands. Being corrupt on a large scale would hopefully require a larger conspiracy.
I'm fine with arbitrary wealth taxes and taxes on capital, with arbitrary justifications, so I'm probably not saying much here; but I'm not in support of a revolving wealth tax.
In Ricardo's simple economic model of "comparative advantage" an entire generation of CEOs and MBAs found justification to sell out corporate capital (everything except the labor, which was laid off) for billions.
A deeper understanding of the economy (not of economic theory necessarily, but of our economy) might have suggested that such a rapid and total sell-off might be very destructive to society.
But greed prevailed and now a generation passed before the full scope of the oversight was realized by most. Society took that long to realize a course correction was required.
Capitalism is be a formidable mechanism for good but pure unfettered capitalism usually has bad "side" effects. That's why we regulate businesses. Sometimes it works.
Its a disconnect powered by propaganda of the definition of "success"
Not saying this is the later case, but when people are critical of large profits they usually are critical of the later, where they believe that the value being created has not really gone up, it’s just being funneled away to rent seekers now.
This is especially true for things that are seen as “essentials” where buying is fairly mandatory and so prices are inelastic, like housing, food and medical care. If these markets become uncompetitive consumers can’t just walk away from rising prices.
So rising profits + the same value being generated point to the market being uncompetitive and are not celebrated in the way rising profits + new value are.
Now they’re learning first hand what happens when it escalates to outright greed and hoarding, and that life gets pretty shitty for the very vast majority when this happens to the basic needs of a decent life (groceries, education, healthcare, safety, roads, transit)
People who run businesses that extract wealth from the sick, the old, the dying, or people in other situations where they are not really able to make free choices, are vile and a cancer on our society.
That is right. But it doesn't mean something cannot be done, such as a general uprising with organized morals against the prevailing winds of profit above all else. Slavoj Žižek said it best when he said that we are conditioned to believe that anything is possible scientifically, but we are highly doubtful of any social change. We need to reverse that: to believe that we can change the world sociall rather than technologically, or perhaps despite the technological changes.