A fascinating Forbes analysis provides a psychological/social explanation for many of the stories currently surrounding the healthcare market in the United States which leave Americans feeling that the system works against them rather than provides a service to them.
The article, “Ethical Erosion: How Good People Lose Their Way In Healthcare,” authored by Sachin H. Jain and published in Forbes, explores the painful discrepancy between the “noble intentions” with which many individuals begin their healthcare careers—aiming “to help people” and “do well by doing good”—and the reality where professionals become “complicit in behaviors that harm the very people we once aspired to serve”.
The core concept is Ethical Erosion, which the author defines as “the gradual wearing away of moral standards”. This shift rarely occurs in a single moment; rather, it “creeps in over time—through small justifications, muted discomfort, and an acceptance that ‘this is just how the system works'”.
The article provides striking examples of this erosion, such as pharmaceutical executives pricing groundbreaking therapies out of reach, hospital leaders engaging in “predatory billing practices that bankrupt families,” and managed care systems denying necessary care despite marketing “generous benefits”.
The psychological engine driving this change is Cognitive Dissonance, a framework offered by Leon Festinger. Dissonance is the discomfort experienced when actions conflict with personal values. To resolve this conflict and preserve their self-image, individuals resort to strategies such as rationalizing their behavior or downplaying the significance of the conflict. These rationalizations, like arguing that high drug prices fund the research pipeline or aggressive billing provides “life-saving care”, allow people to become “numb to the contradictions”.
These small compromises accumulate, leading to a “slippery slope” that resulted in major health crises, including medical bills becoming the leading cause of bankruptcy in the United States and the opioid crisis. The author challenges the common “Broken System” Narrative, which is often used as a defense to “absolve us of responsibility”. The uncomfortable truth, Jain notes, is that “systems don’t break in a vacuum. They break because of the people who work in them”. Blaming the system without accepting personal accountability is considered an act of ethical erosion itself.
The antidote to this gradual decline lies in cultivating “moments of clarity,” which are brief periods when individuals see reality “stripped of rationalizations”.
These moments, often triggered by listening to patients detail their financial devastation or nurses describing burnout, remind professionals that “our compromises aren’t harmless abstractions. They have consequences. They hurt people”. Ethical renewal is achieved not through new mission statements, but through the “discipline of holding on to clarity, even when it is uncomfortable”, committing to accountability, and “living the values we once only wrote on the wall”.
But people who value a moral framework, may also want to consider entrusting part of their healthcare to those who share their values. For people of faith, for example, Christian healthshare ministries offer an alternative to the oft-criticized health insurance system.
There are also healthcare providers who have a faith-based approach to care who Christians may want to prioritize when looking at their options.
If Ethical Erosion is embedded in the US healthcare system – and the evidence suggests that may well be the case – perhaps the answer is to give an Ethical Emphasis to our choices.