As a physician and medical school professor, I breathe a sigh of relief, and thank you for giving us the Patient Protection and Affordable Health Care Act, and the new Patient's Bill of Rights.
Next, how about a Physician's Bill of Rights?
Physicians and hospitals need protection from health insurance companies too, so that we can stay open and provide medical care. We are currently spending about one-third of our resources fighting health insurance bureaucracy in service of our patients, and in the process, many of us are being crushed into closing shop. Little in the current PPACA overtly addresses this.
What good is health insurance for nearly all Americans, if hospitals and physicians keep bankrupting or closing, leaving medical care even more unavailable? Or, if doctors and hospitals have to adopt Wall Street's values in order to stay open?
America's medical system was built largely by non-profit and religious charities over much of the 20th century, which is why so many hospitals are named for saints. Courts once stated that for corporations to profit from medical care was simply "against sound public policy." Yet in the early 1980's, so much got deregulated -- the financial sector, airlines -- and American medicine, too. For-profit corporations, previously held out of medical care, rapidly entered this virgin territory ripe for profit-taking.
Since then, much of American medicine has been dismantled during thirty years of Wall Street's reign on health care. Across the country, institutions like the 150 year old Medical College of Pennsylvania have been bought by for-profit corporations (Tenet, in the case of MCP), and closed, so that profits can be removed from patient care, and given to shareholders and executives. Hospitals which specialize in medical care, not profits, have assumed the moral responsibility of providing care which other hospitals calculate as unprofitable. Nobel Prize winning economist Kenneth Arrow argued that medical care and profit are fundamentally incompatible. Here's some proof -- in the process of practicing good medicine, which turned out to be bad business, even institutions like the 161 year old St. Vincent Hospital in Manhattan have bankrupted and closed.
What are the implications, when medical systems that served through the Civil War, two world wars, the Great Depression and the turn of two centuries -- have found survival in America today, impossible?
In cities across the nation, hospitals have been turned into storefronts for Wall Street corporations even if they retain the names of the local charities which built them. In my home town of Albuquerque, Lovelace Health System is still named for the physician who founded it in 1906. Yet in 1985, this beloved local organization was bought by Cigna, whose stock on the NYSE skyrocketed eight-fold in the next twenty years. Now Lovelace (it's still called Lovelace) has been sold by Cigna to Ardent, a private equity firm, which takes profits from Cigna's leftovers.
The federal government used to fund medical schools, since medical education is usually not profitable or sustainable on its own. But this funding was eliminated in 1980. Today, even at Harvard, medical students complain that their lectures sound like drug ads, since their professors and school are so beholden to money from pharmaceutical corporations.
When I was a medical student in the 1980's, I was taught that each life was equally precious and worth my best effort, and to never discriminate on the basis of a patient's social, financial or insurance status. Yet today, it is impossible for a physician to practice with these same values, and still stay open.
Physicians have born too well the indignity of working in a health care system which mandates us to plead to insurance clerks who know neither medicine nor our patients, but who hold the purse strings on our medical decisions. Patients are often unaware of this, but they feel it in their medical bills -- this crushing, dehumanizing paperwork and bureaucracy accounts for one-third of medical costs. Too often, insurance clerks have informed me of their mission to "educate physicians." They have unfortunately succeeded, since physicians and hospitals increasingly learn that we have to be businesses first, or risk closing. As a remedy, many physicians now have concierge practices which take only money, not insurance, and not patients who rely on insurance.
Using medical lingo, one could even say that Wall Street has been a parasite that has eaten away much of the medical infrastructure of this nation, while transforming what remains.
As we implement and add to the PPACA, it's essential to protect physicians and hospitals still centered on the values of providing medical care in the best interest of patients, and of treating each life as equally precious and worthy. Yet I look at all that's closed and all that's changed, and I wonder if it is already too late. Urgent attention is necessary to preserve what remains -- before all doctors are primarily businessmen, and all hospitals become storefronts for Wall Street -- before the still flickering, ancient flame of the medical profession is completely extinguished in this nation.
I offer this solution. Insurance companies need to be accountable for paying doctors and hospitals -- not the other way around. Physicians, hospitals and medical schools also need protections from the abuses of the health insurance industry.
© 2010 Dora Calott Wang, M.D., author of The Kitchen Shrink: A Psychiatrist's Reflections on Healing in a Changing World