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Grand Unification Theory of Health Care

- Contents -

INTRODUCTION

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

SECTION 2 - The truth about health care rationing

SECTION 3 - Health Care 2000 - how it got this way

SECTION 4 - Secrets of  managed care 

SECTION 5 - Portrait of a modern HMO 

SECTION 6 - The Clintonians Strike Back

SECTION 7 - Rationing and Death - Covert rationing and end-of-life care

SECTION 8 - Fixing our health care system

APPENDIX - Devising a methodology for open rationing

* 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 youíre 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 Ė the stirrings, expressed in vaguely wistful tones, of a more fundamental problem.  And if you listen carefully, what youíll 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 itís something important, something vital, something necessary to the integrity of any health care system.  Itís far more than just a patientís freedom to choose his own physician, or to see a specialist when he wants to.  And itís far more than just a doctorís freedom to practice medicine as she sees fit.  

What weíre 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 isnít, doesnít need to be, and is often stronger if itís not.  Itís not a relationship based on feelings of affection, like those between friends or lovers.  Instead, itís a relationship more like that between allies fighting a war.  Itís a relationship based on mutual dependence and trust Ė 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 todayWe'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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The 5-step chain of logic
of the Grand Unification Theory

1. Health care rationing is an economic imperative.

2. We have chosen to do the necessary rationing covertly.

3. The final common pathway of all covert rationing is 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 that flows from it, is to restore the doctor-patient relationship.

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