Here, I'm referring to myths in the classical sense rather than the vernacular. Thus, a myth is not a lie, but is a story that describes how a people came to be, and why things are as they are.  So, while myths are simply stories, they are extremely important in any society. Myths largely determine how a culture interprets the world around it, and provide a set of guiding principles by which that culture behaves, shapes itself, and responds to events. 

To a large extent, how we think about health care in America is defined by a myth. This myth is a recent one, having taken shape during the last half of the twentieth century, along with the soaring optimism that came with America’s emergence as the world’s greatest power. The myth goes something like this: In America we have and will continue to have the best health care in the world, the best doctors, the best hospitals, the best technology. Every American citizen deserves – indeed, has a right to – access to that best medical care. Since one cannot place a price on human life, everything that can be done for a sick person must be done, as long as there is some small hope of a beneficial outcome. Finally, every disease is potentially curable, and as a matter of policy we will strive to learn how to cure every disease. Indeed, disease, suffering and even death itself are entirely unnecessary for Americans, being merely manifestations of insufficient technology (a deficiency which we must soon fix, certainly before any of us die).

The myth of American health care can be summarized thusly: where health care is concerned, there are no limits.

For the most part this myth has been an extraordinarily useful one.  The essential optimism of our health care myth, and the single-minded efforts it has engendered, have led to amazing advances in the treatment of many formerly devastating diseases. Hospitals in almost every major American city are on a par with the world’s best, our physicians are the best trained in the world, and our biomedical industry is the envy of every other country. While no one can argue that all Americans receive the very best care, on the whole all but our most disadvantaged citizens have access to some of the best medical care in the world.

Unfortunately, this myth is completely incompatible with our economic imperative to ration health care. We have no choice but to ration, and so we are rationing - but at the same time we cannot let go of our myth of "no limits." 

And this is the essential problem. The policymakers who are trying to fix our health care crisis - which means they are determining, covertly or not, the best way to ration health care - are still captured by the myth. They must endorse the myth, or the people would not allow them to remain policymakers. 

What we need is a new myth. As long as we cling to the old one, our health care rationing will continue to be conducted covertly. And policymakers will have no choice but to continue turning the screws on the doctor-patient relationship, unleashing ever more irresistible forces compelling doctors to pay progressively less attention to their individual patients, and progressively more to the desperate, cost-cutting needs of society.

Back to news and commentary

YourDoctorintheFamily.com Home Page