Sunday, August 19, 2007

Government vs. Market Reform - Action, Not Name Calling

Calling health reformers and health plan and government officials “commies,” “fascists,” or “socialists,” and lashing out at “corporations,” helps frustrated doctors blow off steam, but name calling isn’t helpful in advancing our cause, doesn’t solve any problems, and isn’t particularly realistic.

The reality is we’re part of the $2.2 trillion U.S. health industry, which costs the average American family $12,000 a year. We are, to use Arnold Redman’s 1982 term, part, of the “medical industrial complex,” an integral part to be sure, but still just a part of the vast American health system.

Redman warned of a profit-making companies taking over health care. Redman was half right. He left out one crucial element, the government. The truth is physicians one segment of the medical government industrial complex. Government pays for about 50% of health costs, and industry for the other half.

This near-equal sharing of health expenditures has led to interlocking government and industrial triangles.

• The Government Iron Triangle. In the triangle’s three corners are, 1) 110 million Medicare, Medicaid, and VA beneficiaries; 2) 100,000 bureaucrats, public and private, thriving on government health care laws; 3) 535 politicians in the House and Senate who seek votes by instituting and institutionalizing health care entitlement programs and handing out health care goodies.

• The Private Iron Triangle, in one corner, are the health care institutions – 5000 hospitals, 125 academic centers, 100 or so large integrated systems; in the second corner, 1500 HMOs and PPOs and other forms of managed care; and in the third corner, supply-side companies – pharmaceuticals, device manufacturers, IT technology firms, hospital buying chains, medical supply companies.

Ninety percent of patients first enter the system through our offices, so we’re right in the middle of both triangles. We are, in fact, at the base of both triangles, which is why I believe we are most effective in changing the system from the bottom-up rather than the top-down.

Those who work for public and private organizations within these two huge triangles aren’t doing anything illegal or subversive. They simply control and manage a continually evolving American system. They represent a reality. The truth is our society entrusts large organizations, run by managers, to perform major social tasks, whether economic performance, health care, or education. We all know this, even as we rebel against it.

As independent physicians, our job becomes to work within the context of these organizations to do the best we can. Calling those who administer the medical government industrial complex names isn’t going to do any good, though calling people names makes us feel good.

Our alternatives are to form our own countervailing organizations, to work together to arrive at solutions, to work as leaders within the two triangles to bring enlightenment, to gain and justify the trust of our patients, and to manage and innovate to maximize our individual effectiveness as healing professionals.

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