When evaluating the role competition has in the delivery of healthcare, it is useful to discern whether the competitiveness is extending the collective life span, or is shortening it; and whether the quality of life is being improved, or not.
In some cases, the competition will shorten the of the lifespan, and in some cases it will extend it.
An example of competition shortening the collective quality/quantity of lifespan can occur in the case of extremely high-paid healthcare executives. Take a CEO of a certain healthcare corporation that I am familiar with. It is my understanding that this CEO made $11 million last year (all streams of compensation included). Had this CEO been able to find it in himself to be content on $1 million a year, the remaining $10 million could've been used to hire 100 extra nurses at $100,000/year (rough estimate including all benefits and costs). These 100 extra nurses could have substantially elevated the level of care on 100 shifts in the nursing homes of his corporation. More errors would be caught, fewer medical issues swept under the rug. This CEO might say that because executives of his caliber are strongly remunerated, we all benefit. But that would not addressing the fact that this CEO could simply say, "I will make an adjustment in my attitude and lifestyle which will greatly benefit thousands of people. I will take one zero off my compensation package and still be very well off. It's all up to me and my ability to change my attitude." Because of excessive competitiveness, in many cases, this simple adjustment in one's outlook is not made.
This is where the downside of competition comes in. Competitiveness can become malignant and metastasize into greed. The competitiveness can cease to be on the behalf of those one is supposed to serve, and become more on the behalf of one's self. Service to others becomes selfishness. (Lee Iacocca said that of the seven deadly sins, he was convinced that the worst was greed. I believe that this quote was in his book "Talking Straight," though it may have been in the book "Iacocca.") There can be all sorts of rationalizations for this, none of which hold water, as far as I have seen. (One example is, "I've provided added value for the shareholders, so I deserve to be compensated.")
On the other hand, competitiveness can improve healthcare. Competition to come up with the newest, most powerful and low-cost diagnostic procedure can obviously extend the collective quality life span. But even in that case, the malignancy of greed can undermine some or even all of the good.
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