Arnold Relman recently wrote an Essay that was published in the British Journal of Medicine, and I saw some commentary on it today in Physician's First Watch for May 15, 2012. From what I have been able to dig up so far, I agree with his observations, but don't think his fix is the best solution. I will share what I have found so far, and follow it with my reaction. You know up front, that I am an advocate for Non Profit Doctor Patient Cooperatives, but let's see what Dr. Relman, professor emeritus of medicine and social medicine, Harvard Medical School, Boston, Massachusetts, USA, had to say.
First directly from
Physician's First Watch for May 15, 2012
David G. Fairchild, MD, MPH, Editor-in-Chief
After 30 Years, Still Warning About the Direction of U.S. Healthcare
Dr. Arnold Relman, who first warned in a 1980 essay against the rise of the "new medical-industrial complex," offers another warning, this time in BMJ. (Clinical Conversations has an interview with him. Listen via the link below.)
While Relman's 1980 essay called for more study of an emerging situation in which market forces were distorting the U.S. healthcare system, he now describes a system headed inevitably toward bankruptcy and in need of major reform. Physicians, fully aware of what their reimbursements will be, have strong incentives to be "overly generous" in recommending services, he writes, but they remain mostly "unfamiliar with the charges made to insurers [and others] for the services they recommend."
He recommends, among other things, the reorganization of the U.S. system into "private, non-profit, multispecialty group practices, in which physicians are paid largely or entirely by salary." He predicts "fierce resistance" to reform "from all those with vested financial interests in the status quo."
This commentary had three links
BMJ article (Free abstract)
Clinical Conversations interview (Free)
NEJM 1980 article (Free abstract)
Below is the BMJ abstract of the essay ... I did listen to his interview, but have not yet read the complete essay.
"Why the US healthcare system is failing, and what might rescue it
Cite this as: BMJ 2012;344:e3052
The US healthcare system seems headed for bankruptcy because of its ever increasing and unsustainable costs. These costs will be effectively controlled only by legislative reforms in the insurance and payment for medical care, but the prospects of such legislation will depend on a more favourable political climate and stronger public support. However, legislation will accomplish little unless the organisation of medical services also changes. The recent movement of US physicians into large multispecialty groups suggests that this reorganisation of medical care may already be under way. If this trend continues, it could not only facilitate the enactment of legislation, but also help to make our medical care much more affordable and efficient.
At present, most US physicians are in solo practice or belong to small, single specialty partnerships, but new social and economic forces are beginning to make employment in large multispecialty groups a more attractive option. About a quarter of all US practitioners are now employed in such groups, which are being formed by independent physician organisations and by hospitals. If their number continues to increase and if they eventually represent the great majority of practising physicians, a wave of legislative reforms could be initiated that transforms our currently dysfunctional healthcare system. But before I say more about this move towards group practice and how it might improve prospects for reform, readers need to understand how and why our health system … "
My Readtion ...
I appreciate the fact that I am not the only Doc who sees the inevitable implosion of the "Business of Medicine" as we know it, and I would like the pleasure of reading your entire article, so that I may comment on it in a comprehensive way.
As a participating observer for over 30 years, from my "front lines and boots on the ground" perspective, the "Business of Medicine" has hijacked the Doctor Patient Relationship to take Profit away from patient care, without benefit to patients or providers. Pushing toward $$$ = assembly line care, return on investment, care lines, product lines, reimbursement for technical and categorical (reimbursable) services has made it impossible to give HUMAN care ... as we now only pay for "indicated" procedures "proper" diseases. Clearly, business only cares about those things that bring $$$, consequently, much of what real people need, the stuff we used to do for free, or on a fee for service basis, or in trade, or for love(personalized care) is left to fall through the cracks. And, that says nothing about the people who have no care, because the monster providers just ... do not care ... except for money.
Of course, they don't care, because there is no money in it ... if it does not have a code, or $$$ return attached to it, forget it. "Dysintegrated care" or "Disintegrated care" (my pet phrase) IS the current "health care system". And, as it has become progressively more complicated and progressively deteriorated over the years, IT continues to promote ITSELF (the third parties) to the detriment of Patients and Doctors. Yes, disintegrated cafe is promoted by the "business of medicine" ... of course, because the focus on technical stuff and disease works for the third parties. Precisely because it consistently fails Patients and Doctors, the third parties get more money in the process. Yes, the "Business of Medicine" just does not work and can not work ... ever ... for Patients and Doctors. And, I don't see that the bandaids will work either, because they enable, endorse and foster the current mess. For that reason, I advocate a paradigm shift ... back toward the Doctor Patient Relationship.
For the last decade, or so, I have been advocating the formation of Non Profit Doctor-Patient Cooperatives ... building greed and third parties out of it as much as is possible. My hope is to set one up by the end of this year. We will see how it goes. Most Doctors seem to be quite content to follow the money ... they seem to be blinded by it, as they can't see they are about to fall off a cliff and drag all the patients with them.
Join me in working toward the New Paradigm in Healthcare: The Non Profit Doctor Patient Cooperative
Respond to this blog, or email me at dr.mike@ihealsolutions.com and thanks for your support. We are all patients at one time or another and who wants to be left flat by greedy business people?
Dr. Mike
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