When medicine can heal—but the market decides who is allowed to recover
By Prof. MarkAnthony Nze
The Cure Economy
The cure is always announced with ceremony.
A press release. A stock surge. A promise framed as a breakthrough. The language is triumphant, almost moral: historic, life-saving, transformational. Yet beneath the celebration lies a quieter, unresolved question—one that modern medicine rarely confronts honestly: what happens when curing disease threatens the business of treating it?
In today’s health system, a cure is no longer just a scientific achievement. It is an economic event. It must justify its price, defend its exclusivity, and preserve the financial ecosystems it disrupts. A therapy that ends demand is not merely revolutionary. It is destabilizing.
This is the paradox of the cure economy: medicine can heal more than ever before, yet healing itself has become conditional.
When Healing Breaks the Business Model
For decades, healthcare has been organized around chronicity. Long-term treatment plans, repeat prescriptions, ongoing monitoring—these are predictable, billable, and investor-friendly. A patient who manages disease indefinitely generates stable revenue. A patient who recovers fully does not.
This logic is not speculative. Health economists and policy analysts have repeatedly shown that financing structures reward maintenance over resolution. As Berwick (2023) warned in JAMA, the moral center of healthcare is eroded when systems normalize profit from prolonged illness while treating cures as financial anomalies.
The cure disrupts cash flow.
It shortens timelines.
It collapses markets.
In a system optimized for return on investment, that disruption is not always welcome.
The Price of a Cure
Nowhere is this tension clearer than in gene and cell therapies—treatments designed to correct disease at its source, often with a single intervention. These therapies represent genuine scientific triumphs. They also arrive with price tags that redefine affordability.
Recent analyses of gene therapy valuation show prices reaching into the millions of dollars per patient, justified by the promise of lifelong benefit (Garrison et al., 2019; Wagner et al., 2025). Payers are told these prices reflect innovation, risk, and long-term savings. Yet budget impact studies reveal a harsher reality: even when therapies are “cost-effective” on paper, they are frequently unaffordable in practice (DeMartino et al., 2021; Wong et al., 2023).
A cure that exists but cannot be accessed
is not a cure.
It is a privilege.
Affordability as the New Rationing
Rationing once carried political stigma. Today it hides behind actuarial language.
Cost-sharing mechanisms, coverage exclusions, prior authorization, and eligibility thresholds quietly determine who receives curative care. According to the Commonwealth Fund (2023) and Kaiser Family Foundation (2025), high healthcare costs remain a primary reason patients delay or forgo treatment—even in high-income countries.
The result is a system where cures are theoretically available but practically unreachable for millions. Ability to pay becomes the final clinical criterion. Need becomes secondary.
Access is no longer denied outright.
It is priced out.
Value-Based Care—or Value for Whom?
The cure economy often defends itself using the language of value. Value-based pricing, outcome-based contracts, and shared-risk agreements are presented as solutions to affordability. In theory, they align payment with benefit. In practice, they often protect manufacturers more than patients.
White papers from ICER and related policy bodies acknowledge that while innovative contracting can distribute risk among payers, it does little to address upfront price barriers or global inequities (Phares, 2024). These models assume robust insurance systems, administrative capacity, and stable patient tracking—conditions absent in many settings.
Value is measured financially.
Justice is assumed, not ensured.
Cures That Collapse at Borders
Global inequity is the cure economy’s most visible failure.
Therapies developed using global data—sometimes including trials conducted in low- and middle-income countries—are priced almost exclusively for wealthy markets. Reporting by Reuters (2024) and AP News (2023) documents how cutting-edge gene therapies remain inaccessible outside a handful of countries, even when disease burden is highest elsewhere.
Patents protect innovation.
Pricing protects markets.
The result is a two-tiered world of medicine: one where cures exist, and another where they remain theoretical. Humanity becomes segmented by purchasing power.
A cure that stops at borders
is not global health.
It is selective salvation.
Public Health, Quietly Sidelined
Public health once offered a counterweight to market logic. Vaccination, sanitation, clean water, and disease eradication prioritized collective benefit over individual profit. Their success was measured in absence—in outbreaks prevented, lives quietly saved.
Over time, these approaches have been underfunded and overshadowed by biomedical solutions. Prevention does not generate patents. Its victories are invisible. As health financing data show, investment continues to skew toward downstream treatment rather than upstream prevention (Commonwealth Fund, 2023).
The cure economy prefers interventions that can be sold.
Prevention resists monetization.
Clinicians Trapped Between Ethics and Economics
Clinicians experience the cure economy not as theory, but as daily constraint.
They are not trained to heal in the human or holistic sense; they are trained to treat—to manage symptoms, stabilize conditions, apply protocols, and reduce measurable risk. Hospitals do not promise healing. They promise intervention. Within this framework, clinicians practice inside systems governed by formularies, reimbursement codes, coverage limits, and utilization thresholds.
They often know when a patient could meaningfully recover—when a curative or definitive intervention exists—but they also know when that option will be denied, delayed, or rendered financially catastrophic. Clinical judgment does not fail here; economic architecture intervenes.
Treatment proceeds. Healing remains aspirational.
Clinical judgment bends around affordability.
Ethical care bends around coverage.
The system does not ask whether a cure is right.
It asks whether it is reimbursable.
Read also: Diseases That Pay: The Global Health Economy—Part 6
Profit as Policy
The cure economy persists because it is politically protected.
Pharmaceutical firms are employers, investors, and donors. Pricing debates are framed as threats to innovation. Reform proposals are recast as anti-science or anti-progress. As policy analysts note, resistance to cost containment is rarely about evidence—it is about power (Essien et al., 2022).
Markets do not self-correct toward equity.
They defend advantage.
Without strong public intervention, profit remains the primary arbiter of access.
Is Profit Compatible with Healing?
This is the question ethicists increasingly confront directly.
The AMA Journal of Ethics has raised a blunt challenge: can a system organized around profit still claim moral authority in healthcare (Zeitouni, 2025)? The answer depends on boundaries. Profit can coexist with care only when it is constrained—by regulation, public investment, and ethical commitment.
When profit becomes sovereign, medicine becomes transactional. Healing becomes conditional.
What a Different Future Would Require
A rehumanized cure economy would look radically different.
Publicly funded research insulated from commercial pressure.
Open science collaborations that prioritize access.
Tiered pricing structures tied to global equity.
Strong investment in prevention and primary care.
Global agreements that treat lifesaving cures as public goods.
These are not utopian ideas.
They exist in fragments.
They fail to dominate because they threaten entrenched interests.
The Quiet Reckoning
The cure economy teaches us how to live longer with disease.
It has not yet decided whether it truly wants to end disease.
As long as cures must first satisfy markets, healing will remain conditional—rationed by price, geography, and power. Innovation will accelerate. Access will lag.
The final test of a health system is not how advanced its technology becomes.
It is whether a sick person, regardless of wealth or location, can expect to be healed without being ruined.
That expectation is no longer guaranteed.
In many places, it is no longer reasonable.
And until societies choose to value recovery over revenue, the cure will remain what it has quietly become:
a triumph of science,
and a negotiation of economics.
Professor MarkAnthony Ujunwa Nze is an internationally acclaimed investigative journalist, public intellectual, and global governance analyst whose work shapes contemporary thinking at the intersection of health and social care management, media, law, and policy. Renowned for his incisive commentary and structural insight, he brings rigorous scholarship to questions of justice, power, and institutional integrity.
Based in New York, he serves as a full tenured professor and Academic Director at the New York Center for Advanced Research (NYCAR), where he leads high-impact research in governance innovation, strategic leadership, and geopolitical risk. He also oversees NYCAR’s free Health & Social Care professional certification programs, accessible worldwide at:
👉 https://www.newyorkresearch.org/professional-certification/
Selected Sources
Berwick, D. M. (2023). Salve lucre: The existential threat of greed in US health care. JAMA, 329(8), 629–630.
https://doi.org/10.1001/jama.2023.0846
Commonwealth Fund. (2023). Income disparities in the affordability of health services across high-income countries.
https://www.commonwealthfund.org
DeMartino, P., et al. (2021). Budget impact analysis of gene therapy for sickle cell disease. JAMA Pediatrics.
https://doi.org/10.1001/jamapediatrics.2021.7759
Essien, U. R., et al. (2022). Cost-sharing reform for improved health care equity. JAMA Health Forum.
https://doi.org/10.1001/jamahealthforum.2022.27999
Garrison, L. P., Jr., et al. (2019). Value-based pricing for emerging gene therapies. Journal of Managed Care & Specialty Pharmacy.
https://www.jmcp.org/doi/10.18553/jmcp.2019.18378
Kaiser Family Foundation. (2025). Americans’ challenges with health care costs.
https://www.kff.org
Phares, S. (2024). Managing the challenges of paying for gene therapy. ICER & NEWDIGS.
https://icer.org
Reuters. (2024). Gene therapy pricing reignites access debate.
https://www.reuters.com
AP News. (2023). Promising gene therapies remain inaccessible in low-income regions.
https://apnews.com
Wagner, T. D., et al. (2025). Innovative contracting for gene therapies. Pharmacoeconomics.
https://doi.org/10.1007/s40273-025-01563-3
Wong, C. H., et al. (2023). Financial impact of gene therapy on health systems. Journal of Community Genetics.
https://doi.org/10.1038/s41434-023-00419-9
Zeitouni, J. F. (2025). Is pursuing profit commensurate with providing good health care? AMA Journal of Ethics.
https://journalofethics.ama-assn.org
