The Responsible Physician: Part II

Why should it seem to be a paradox for physicians to manage healthcare? Many blame physicians for the system’s failure. Deterioration in cost of care, ease of access, and availability of services all seem to point toward the profession. Yet it is the constancy of the physician’s dedication that sustains healthcare. Despite steady erosion of income and increased bureaucratic intrusion the profession soldiers on. The myriad factors which sustain the current US system are nicely described in the New England Journal of Medicine by Lawrence D. Brown. But he missed one critical factor. All of the compensating factors he mentions depend upon the input and even generosity of physicians. The system continues to function because the profession consistently places the welfare of its patients above its own. There is an essential iniquity in a society that exploits the humane spirit of its medical profession to sustain its failed healthcare.

Arms length fiscal management of healthcare by government or third party payors is limited as to methods of control. They may either reduce payment, deny access or ration care. There is no subtle human touch to these methods. Their outcome is readily apparent. To persist with these methods only succeeds in ratcheting up the anguish for patients as they recognize the deterioration in their access to care. Yet those with fiscal power persist, knowing that no healthcare system has ever pushed the limits far enough to cause its physicians to leave their post. It is this loyalty that patients can trust.

Ultimately successful healthcare reform must depend upon the appropriate alignment of self-interest.

End of Part II.