The American Health Care System Explained at Last!

* The Grand Unification Theory of Health Care *

Introduction

Whenever you bring up the subject of health care today, whether to doctors or to patients, you  immediately get an earful. You'll hear about the greedy, heartless HMOs; the growing difficulty in getting health insurance (whether you’re employed or not); the distracted, money-grubbing doctors; and the overly demanding and increasingly litigious patients.  

Yet, despite this litany of grievances, you will find it strangely difficult to put your finger on what, exactly, the real problem is.  For underlying these more concrete complaints you will perceive something else – the stirrings, expressed in vaguely wistful tones, of a more fundamental problem.  And if you listen carefully, what you’ll hear is the expression of a deep, if poorly defined, sense of loss.

The sense of loss is genuine.  Because something is being lost, and it’s something important, something vital, something necessary to the integrity of any health care system.  It’s far more than just a patient’s freedom to choose his own physician, or to see a specialist when he wants to.  And it’s far more than just a doctor’s freedom to practice medicine as she sees fit.  

What we’re losing, we doctors and patients, is the sanctity of our relationship with one another.  

Wait - don't go.

I promise I'm not going to get all warm and fuzzy about the importance of relationships.  For, while the relationship between patients and their doctors can be warm and fuzzy, it usually isn’t, doesn’t need to be, and is often stronger if it’s not.  It’s not a relationship based on feelings of affection, like those between friends or lovers.  Instead, it’s a relationship more like that between allies fighting a war.  It’s a relationship based on mutual dependence and trust – on mutual survival, in fact.  We, doctors and patients, allow this relationship to weaken only at our own peril.

And that, it turns out, is the heart of the problem. The traditional doctor-patient relationship, so vitally important to all of us, is being systematically and methodically destroyed. 

When you understand why and how this is so, then all the pieces of the health care puzzle instantly fall into place. Previously inexplicable events become not only logical, but predictable.  And potential solutions to our health care crisis, both long term and short term, immediately begin to materialize. 

This synthesis is laid out in what I humbly call the Grand Unification Theory of Health Care - the theory that explains everything.

The Grand Unification Theory rests on a simple, 5-step chain of logic:  

1. The rationing of health care is an economic imperative, and cannot be avoided. 

2. Since the very notion of rationing health care is taboo on our society, the necessary rationing must be done, and is being done, covertly - that is, without acknowledging that any rationing is occurring.

3. Covert rationing fundamentally works by applying coercive pressure to the focal point of all health care spending, namely, the physician-patient encounter. Thus, the final common pathway for all covert rationing must be - can only be - destruction of the doctor-patient relationship.

4. Loss of the doctor-patient relationship is fatal to the medical profession, life-threatening to patients, and debilitating to society. 

5. The key to defeating covert rationing, and all the evils that flow from it, is to restore the doctor-patient relationship.

In the sections that follow, we'll see how the Grand Theory explains everything going on in the health care system today.  We'll also see how it points us toward long-term solutions to our growing health care crisis, and toward actions we can take to protect ourselves in the meantime, until such long-term solutions can take hold.

Next: SECTION 1: The importance of the doctor-patient relationship, and why we can't have it anymore

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