A member of the Medical Economics editorial board discusses what he sees as the differences between state-backed healthcare and patient-focused healthcare.
In the practice of medicine over thousands of years, the prime directive has been the interests of the patient. The secondary directive has been that of physician interest to sustain the practice, himself or herself, and his or her family. The tertiary directive is that of society.
Throughout human history, until the end of the 20th century, the patient interest has been primary. Individual patient needs and wants have been the number one focus of the doctor’s time and attention.
Somewhere in the middle to the end of the 20th century, focus shifted from individual patients to the concerns of employer-sponsored third-party payers.
In certain empires in history, such as those of Plato’s republic, when the state’s interest were made primary, physicians responded to the needs of the state by devoting resources to the workers, in the process ignoring the elderly, very young, critically ill, and those who were considered genetically inferior. Such practices can lead to vile immorality and atrocities.
In the 21st century, with the Medicare and Medicaid programs and passage of the Affordable Care Act, is the United States moving toward socialized medicine? In this form of medicine, the state owns the healthcare system and all the resources therein. This arrangement allows the state to act in its own self interest, not in the interests of individual patients.
A WORLDWIDE TREND
Our country would not be alone. Socialized, or government-owned and run medicine, appears to be the trend in the developed world, such as the United Kingdom (U.K.) and Canada.
The problem is, like in other socialist government programs, it is all good until “you run out of someone else’s money,” as former U.K. Prime Minister Margaret Thatcher said. Then the ethical decline begins as care is rationed for the able workers and withheld from the sick babies and the declining elderly. Every citizen languishes in the notion that he or she will be cared for when ill or hurt by some other responsible party.
INDIVIDUAL VERSUS SOCIETY
The contradiction of public health “greater good” out-competes the needs of each individual. This is Plato’s concept of state medical care.
It seems to me that the United States, rather than legislate the pure socialized medicine that is failing in most major industrialized nations, is moving toward a system of private industry ruled by the state and federal governments. This form of medical care may reduce medical expenditures and save government money, but it does so at the price of refusing procedures that physicians deem necessary. The result is similar to socialized medicine: minimal health maintenance of the workforce; death of the frail, young, and old; and the destruction on the doctor-patient relationship.
Medical care based on such principles can result in discrimination against individual patients to meet government rules. It can cause an insurmountable conflict of interest for all those who practice Western medicine, who were taught to provide and swore to uphold the Hippocratic oath.
So whom will we follow, Plato or Hippocrates? Healthcare directly paid for by the patient, wherein physicians are beholden only to the patient, in my opinion, is the only true care model that abides by the ethics of that oath and current medical training standards. I think we’re wasting time, money, and lives if we pursue anything else.
The author practices in family medicine in Mullica Hill, New Jersey. From the Board columns reflect the opinions of the authors and are independent of Medical Economics.
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