Fred Goldstein, a health care veteran who believes in the free market, calls a spade a spade in a hard hitting call for ethical improvement in health care over at HealthLeaders. Go read his list of transgressions which we all know about individually but are hard hitting when read together. Bonus points if you can name the guilty. His point is that it’s pervasive because we’ve collectively let it happen. Here’s his conclusion.

Unethical behavior exists among healthcare organizations and professionals of all types. Organizations that try to do the right thing are often outmaneuvered by those that do not. Self-interest is often hidden behind a facade of patient concern. “We do this for the patient. If you withhold our services, you will hurt the patient.”Worse, these self serving behaviors have become so common that professional outrage has been dulled. But to save healthcare, we can’t just take these acts for granted. The prevalence of inappropriate actions in healthcare drives additional margins in the industry’s supply, delivery and financing sectors. It is at the root of our cost explosion and our healthcare crisis. And, it is based on an ingrained acceptance of unethical behaviors.The recent movement toward transparency and quality reporting will shine a bright light on some of these practices, and should tone down the environment of opportunism. But many of these behaviors have been well known for years. I have little faith that, with so much money at stake, any reforms can be substantial enough to turn around the industry. This is especially true if change does not support and engage much more participation from payers and consumers.