Fixing our health care system - what needs to happen

Any movement toward open rationing certainly won’t be initiated through the political process. A politician would probably be in less trouble for standing up at an AARP convention and endorsing Social Security cuts than he would be for speaking out publicly about rationing health care. The process of changing the health care system, of course, will have to be largely political. But before politicians will ever initiate or even permit such a process, they will have to understand, on no uncertain terms, that change is necessary, desired, and demanded by the people. Politicians won’t lead us there. They won’t even be led there until they know it is safe.

Nor will a public discussion on open rationing be initiated through the market forces. As long as the Gekkonians are making money running health care, there is no reason for them to push for some other system. And when they stop making money, they’ll just get out of the business.

The medical profession won’t be able to get things started, either. I am convinced that most doctors, deep down, understand fully that we’re rationing our health care, and that the way we’re doing it is wrong. Many doctors are greatly disturbed by this, and would be quite ready for a radical change in the health care system that restored a measure of equity and sanity. But doctors have been systematically marginalized within the health care system, and today have little authority on policy matters. Worse, by virtue of the fact that they actively participated in driving up the costs of health care over the past several decades (by adopting and encouraging the use of expensive therapies and technologies without insisting on reasonable scientific rigor, helping to create unreasonable expectations on the part of patients and society, and, in many cases, engaging in extravagant, ostentatious, out-and-out profiteering), they have lost much of their vaunted moral authority. When doctors complain today about the state of the health care system, their motives, understandably, are highly suspect. Just whose welfare are they concerned about, anyway?

Ultimately, any real impetus to change the health care system can come from only one place – from patients, that is, from the public. Only the public has the real power to demand change. The public is paying for the whole show (and the government and the employers that normally get the “credit” for paying for health care merely serve as agents for passing along the public’s money). And it’s not only the public’s money, but also the public’s health that is at stake. So, while patients have been systematically marginalized just like doctors, they have retained both the fiscal and the moral authority to demand change.

If the public should ever begin really clamoring for change, their power would be utterly irresistible.

How can such a public passion be engaged? How can we even begin to bring “the public” around to any sort of consensus on health care? What will cause the public to demand the sort of open discussion we really need – a discussion that genuinely addresses the real problems of the health care system, and what we should do about those problems?

There is probably only one way to begin to accomplish this. First, the public needs to be made aware of what already has been lost. And then, once aware, they will need to demand the return of what is traditionally, legally, morally and rightfully theirs – they will need to demand that their doctors be allowed to return to acting primarily as their advocates.

That demand, if firm enough and persistent enough, will bring the entire house of cards crashing down. Covert rationing relies utterly on rationing at the bedside, and simply will not be able to survive a restored doctor-patient relationship. And if covert rationing falters, then we will have no choice but to finally, openly and explicitly decide how we really ought to ration our health care. That all follows naturally.

Firmly demanding restoration of the doctor-patient relationship is all it will take.

So the answer, in concept, is really quite simple. Patients and doctors will have to forge a new pact with one another, a pact based in mutual need and mutual trust – like allies fighting a deadly mutual enemy. Patients will need to insist that doctors act primarily as their advocates, guarding their personal rights and welfare to the best of their abilities, within the bounds set by society. They will need to demonstrate their willingness to protect the medical profession’s advocacy role from external attack, whether from Gekkonians or Clintonians. And doctors, in return, will need to agree to return to their primary role as their patients’ advocates, leaving all other professional concerns to only secondary importance. These secondary concerns include income, job security, and prestige.

Both doctors and patients will have to embrace anew the sanctity of the doctor-patient relationship, and place it at the center of all health care. And any earthly power that tries to drive a wedge between them will have to understand it will have hell to pay.

It should be clear that such a new pact between doctors and patients does not have to (nor will it) arise from civic-mindedness, moral outrage, or a belief that openly rationing health care is the right thing to do. The new pact, if it occurs, will arise out of a very primitive (and very reliable) instinct – the instinct for self-preservation. For without such a pact, the rights and welfare of each of us as patients, and the very survival of medicine as a profession, are doomed.

So, if I'm right, all that needs to be done is to get the message out: The doctor-patient relationship is being systematically destroyed, and if it is destroyed, each of us individuals is in big trouble.

To get that message out, I have a modest proposal.

Next: Personal Health Care Advocates

Return to YourDoctorintheFamily.com home page