Sachin H. Jain: Ethical Erosion And The Deafening Silence Of America’s Healthcare “Leaders”

Sachin H. Jain, President and CEO of SCAN Group and Health Plan, posted on LinkedIn:

“The term ethical erosion is used to describe the ‘gradual decline in values, beliefs, and truths.’

I first encountered this term in medical school to describe the loss of empathy and caring as students progressed from the first year of medical school through the end of their training. Incoming medical students presumably carry pure values.

As they write in their medical school applications, they express that they want to ‘help people.’ But, by the end of their training, they are sometimes found to be hardened and less empathetic than they once were. The medical student who once hugged his suffering patient may later in his career fail to make eye contact with a patient or return a phone call.

Simply stated, their ethics have changed – or eroded. This Martin Luther King Jr. Day, I woke up wondering about ethical erosion as it pertains to people who work on the business side of healthcare. Many (like me) who go to work on the business side of healthcare do so because we believe that we can contribute meaningfully to society while making a good living.

But years into our careers – after being socialized into the industry – something changes. We no longer struggle with the authenticity of our corporate pablum. We stop worrying if the products and services we sell are bankrupting people and societies.

We stop struggling with the human impact of our decisions. Abnormal behaviors and practices begin to feel normal. The realities of holding on to a job or keeping a company alive supersede any antecedent personal ethics. The making a living part of the equation completely squashes the notion of societal contributions. ‘I have a kid to send to college.’ ‘I have a boss that needs a result.’ ‘I have shareholders who expect a return.’

When pushed about any obviously objectionable aspect of our business (pricing, access failures, denial rates, healthcare disparities as examples), we fall back to the ‘broken system’ explanation. We might say, ‘We are just doing our best with the incentives or constraints that we have.’ Or we might engage in deflection:

The pharmaceutical executive blames the health plan. The health plan executive blames the doctors. The doctors blame the government. And so on and so forth. The broken system explanation is easy to accept at face value because, well, it’s true. The system is broken and cracks are too many in number to count.

But the broken system explanation is also a distraction. A distraction that often achieves its intended effect. It takes the heat off of whoever is under the microscope at the moment. It helps avoid close scrutiny of one’s own practices and enables the status quo…

It reflects a deep, false, numbed powerlessness that is the end conclusion of one’s ethical erosion. The pharmaceutical company whose drug is already expensive could commit to not increase the price of its drugs more than inflation. But more often than not, they do not. The insurance company that creates friction denying claims that they will eventually approve could approve the claim faster. But more often than not, they do not.

The non-profit health system that aggressively saddles patients with debt that they will never ever collect could commit to not destroying the credit of their sick and destitute patients. But more often than not, they do not. No changes in regulation are required to implement any of these small, but meaningful improvements on our broken status quo. No changes in the regulatory landscape. No ‘massive’ retooling of the system. No major change in one’s financial model or accounting practices. No, it just requires a more robust ethical framework. A deep belief that everything does not have to be as it is. A burning in your gut desire to be better.

Which brings us to the question of ethical erosion of healthcare leadership and what it means to be a healthcare leader at any level in an organization in the year 2025. I attend many meetings and conferences with healthcare leaders where there is a lot of admiration of problems. And I am guilty of being one of these admirers. There is a lot of discussion of the underlying causes. And potential solutions. But when it comes time to taking actions – even small actions – we again encounter the deep, false, numbed powerlessness.

‘I can’t do anything.’ ‘My board won’t let me.’ ‘My shareholders’ expectations won’t allow it.’ ‘We need a legislative fix.’

Some of which is true, but so much of which isn’t. And so we go to more conferences and talk. And we write articles (like this one). And lull ourselves into the idea that we are making a difference through dialog. Or, more ominously, we remain silent. Oh, we remain silent. A sort of quiet sense of misplaced resignation.

Were the people who work on the business side of healthcare to more consistently (and loudly) anchor ourselves to the simple ethics that drew us to healthcare in the first place – ‘I want to contribute to society’ – we might just begin to see ourselves less as helpless, hopeless objects of the system and instead as the drivers of the system. We might not always believe that change needs to come from the outside and instead begin to believe again that it can come from within. And we might just begin to rebuild the trust that we have lost and are continuing to lose.

We might begin to carry the ‘leader’ title in the classical sense of the word – like Dr. King – and do the right thing even when it sets back our picayune interests. Just as the doctor who is no longer compassionate or caring towards his patients should no longer be a doctor—maybe the hopeless, helpless, resigned, and, worst of all, silent, healthcare leader who no longer feels change is his or her responsibility and personal mandate should step away.

Because better, more proactive, more vocal, and more self-reliant industry leadership will be as important as anything to give an angry and disaffected public the kind of healthcare it desperately needs and deserves.”