The Responsible Physician: Part I

As our healthcare system crumbles the mantra of cost containment still emanates from the ruins. Few aspects of healthcare escape this indictment. Physicians, hospitals, pharmaceutical companies and even insurance companies are all cited for their contribution to spiraling cost. But we seem unable to recognize that it is the organization of healthcare itself that creates the problem. As long as the belief is held that fiscal responsibility for care of patients can be divorced from the delivery of that care this chaos will continue. The frenzy to contain cost focuses upon care givers. If only they can be constrained healthcare will be affordable.

This is clearly not an effective strategy.

Fee-for-Service has lost fiscal relevance

Physicians are blinded by their own ethic. They believe that the exchange of fee-for-service is a sufficient representation of the fiscal and moral obligations that exist between patient and physician. This was true when medicine was a cottage industry. But fee-for-service long ago lost any real fiscal relevance. Yet physicians still cling to the illusion that their integrity is sufficient protection for their patients and themselves. But those with real fiscal power impose restrictions in the name of cost control that render that integrity impotent.

Physicians as insurers

We need to consider a paradoxical solution. If the physician is responsible for the decisions which drive medical cost then the physician should be in charge.

Establish physicians as insurers with responsibility to average cost across the patient population they insure. Let them form large groups capable of managing both fiscal risk and patient care. To be successful they must forego fee-for-service and in its place, reward achievement.

End of Part I.