Sick Is More Profitable Than Healthy: How the Healthcare System Is Built to Treat, Not Cure
I want to start with a quote. Not from a conspiracy theorist. Not from a fringe website. From Goldman Sachs.
In April 2018, Goldman Sachs analysts published a report on genome medicine called "The Genome Revolution." In it, they asked a question so cold and revealing that it should have made front-page news everywhere. The question was: "Is curing patients a sustainable business model?"
Read that again. One of the most powerful financial institutions on the planet was advising its biotech clients that curing people might be bad for business. Not as an accusation. As a genuine investment concern.
That one question tells you more about the American healthcare system than a thousand policy papers ever could.
This Isn't a Conspiracy. It's an Incentive Structure.
I want to be precise here, because precision matters when we're talking about something this serious.
Nobody is sitting in a room deciding to let people die for profit. There is no vault somewhere with a cancer cure in it. What there is — and what is far more dangerous because it has no single villain to arrest — is a set of economic incentives that systematically reward chronic treatment over prevention and cure. When you build a market around sickness, the market optimizes for sickness. That's not a moral failing. That's just how markets work when they're pointed in the wrong direction.
The question we should be asking is not "who is evil?" The question is "who built this structure, who maintains it, and who profits from it?"
The Hepatitis C Problem: What Happens When a Cure Works Too Well
Goldman Sachs didn't pull their concern out of thin air. They pointed to a real and instructive case.
In 2013 and 2014, pharmaceutical company Gilead Sciences introduced treatments for Hepatitis C — Sovaldi and Harvoni — that achieved cure rates of over 90%. This was a genuine medical triumph. People who had lived with a chronic, life-threatening infection were being cured in weeks.
Gilead's U.S. sales for these treatments peaked at $12.5 billion in 2015. And then they fell. And kept falling. Goldman projected them to drop below $4 billion just three years later.
Why? Because the drugs worked. They cured the existing pool of patients. And as Goldman's analysts noted, curing an infectious disease also reduces the number of carriers who can transmit it to new patients — meaning the future market shrinks too. The cure undermined the business.
Goldman's conclusion, directed at biotech investors, was that a company developing a one-shot cure needs to think carefully about market sustainability. In plain English: curing too many people too efficiently is a problem for your stock price.
This is not a theory. This is a Goldman Sachs analyst writing to clients in a published report. The incentive structure is documented in their own words.
The Patent System: Engineered for Chronic Revenue
To understand why the system favors treatment over cure, you have to understand how pharmaceutical patents work.
When a company develops a new drug, they receive a patent that gives them exclusive rights to sell it — typically for around 20 years. During that window, they can charge whatever the market will bear with no competition. After the patent expires, generic manufacturers can make the same drug cheaply, and prices collapse.
This creates a very specific economic incentive. A company wants to develop drugs that patients take repeatedly, ideally for life, within that patent window. A drug a diabetic takes every day for thirty years generates thirty years of revenue. A one-time cure generates revenue once.
The result is what the industry calls "me-too" drugs — slight molecular variations of existing brand-name medications designed not to significantly improve patient outcomes, but to secure a new patent and restart the revenue clock. Research published by economist Mariana Mazzucato found that 75% of the research behind the most innovative new drugs traces back to NIH funding — meaning taxpayer money. Pharmaceutical companies then take that publicly funded science, apply a patentable tweak, and sell it back to the public at maximum profit.
You pay for the research through your taxes. You pay again through your insurance premiums. You pay a third time at the pharmacy counter.
The Numbers: Where the Money Actually Goes
The pharmaceutical industry's standard defense against criticism is that high drug prices are necessary to fund research and development. This is, to put it plainly, not supported by the data.
Research by the California Nurses Association found that nearly two-thirds of the 100 biggest pharmaceutical corporations spent at least twice as much on marketing as on R&D. Forty-three of those companies spent five times more on marketing than research. Twenty-seven spent ten times more.
From 1999 to 2018, the pharmaceutical and health product industry spent $4.7 billion on federal lobbying — more than any other industry in America. In 2024 alone, they spent $294 million lobbying Washington. To put that in context, the insurance industry — the second biggest lobbying spender in healthcare — spent less than half that amount.
Research published in peer-reviewed journals has found that the majority of pharmaceutical industry profits don't go back into R&D at all. They go to stock buybacks — purchasing their own shares on the open market to artificially inflate stock prices and reward shareholders. When Pfizer acquired drug company Wyeth in 2008, it immediately slashed the combined company's R&D budget in half, closed research sites, and fired scientists. Financial markets rewarded this decision with higher stock prices.
The story they tell you — that high prices fund lifesaving research — collapses under scrutiny.
The Insurance Problem: Why Even Payers Don't Want Cures
Here's a dimension of this problem that rarely gets discussed, and it's important.
The problem isn't only on the pharmaceutical side. The health insurance system creates its own structural disincentive for cures.
Consider a gene therapy that permanently cures a child's rare disease for a one-time cost of $2 million. An insurance company pays that $2 million in year one. But Americans change health insurance plans frequently — for jobs, for life changes, for open enrollment decisions. The insurer who paid for the cure may not be the insurer who benefits from never having to pay for lifetime chronic treatment. The insurer that gets the patient next year reaps all the long-term savings. The one who paid for the cure bears the entire cost.
Industry analysts call this "patient churn risk," and it creates a powerful disincentive for any single payer to cover high-upfront curative therapies. The economics of a fragmented, private insurance market are structurally hostile to one-time cures.
A single-payer system or national health service has the opposite incentive structure — it pays for the cure today and collects the savings forever. This is one of the core economic arguments for universal healthcare that rarely gets explained in these terms.
Prevention Is the Least Profitable Medicine
If chronic treatment is more profitable than cure, prevention is even less profitable than that.
Prevention means people don't get sick. People who don't get sick don't buy drugs. They don't need hospitalizations, procedures, imaging, or specialist visits. A healthy population is, from a pure market perspective, a terrible customer base.
This is why the United States spends approximately 97 cents of every healthcare dollar on treatment and just 3 cents on prevention, according to data from the Centers for Disease Control. We are, as a nation, almost entirely invested in responding to disease after it occurs rather than stopping it before it starts. Chronic diseases — heart disease, diabetes, obesity-related conditions — account for 90% of the nation's annual healthcare costs and are largely preventable through diet, exercise, and environmental factors.
But there is no patent on eating vegetables. There is no quarterly earnings call for walking. There is no lobbying arm for sleep hygiene. The things that most reliably keep people healthy are not commercially scalable, and so the system has no structural incentive to invest in them.
The Political Capture: How the System Protects Itself
None of this persists by accident. It persists because the pharmaceutical industry has systematically purchased the political infrastructure that would otherwise regulate it.
The industry spent $4.7 billion lobbying the federal government over two decades. That money is targeted with precision — research published in JAMA found it was concentrated on senior legislators involved in drafting healthcare laws, and on state committees weighing drug pricing referendums. When Medicare tried to negotiate lower drug prices, PhRMA — the industry's primary lobbying arm — sued to block it, claiming that lower prices would harm innovation. Their own financial disclosures show they spend more on investor payouts and executive compensation than on the R&D they claim to need those prices to fund.
The revolving door between pharmaceutical companies and regulatory agencies is well documented. Former FDA officials move to pharma industry jobs. Former industry executives move into regulatory positions. The people writing the rules and the people profiting from them are often the same people at different stages of their careers.
This is what regulatory capture looks like in practice. And it is why the system does not self-correct. The people with the power to change the incentives are the same people who benefit from keeping them exactly as they are.
What This Actually Means for You
Here is the bottom line, stated as plainly as I can.
You live in a country where the most powerful industry spends more lobbying the government than any other sector. Where the financial incentives systematically reward keeping people sick over making them well. Where your tax money funds the basic research, your insurance premiums fund the clinical trials, and then the resulting drugs are priced out of reach for the people whose money built them. Where prevention is chronically underfunded because healthy people don't generate revenue. And where the political system that should regulate all of this has been purchased by the very industry it's supposed to oversee.
This is not a conspiracy. It is a system. And systems are changed not by exposing a villain but by restructuring the incentives — through campaign finance reform, through public funding of drug development with public ownership of the resulting patents, through single-payer healthcare that aligns financial incentives with population health, and through an electorate that understands exactly how it is being farmed.
Goldman Sachs asked if curing patients is a sustainable business model. The correct answer is: it depends entirely on who is running the healthcare system and what they're trying to sustain.
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