Magazine article Tikkun

Bad Medicine

Magazine article Tikkun

Bad Medicine

Article excerpt

As a physician, I have spent the last year watching the rapid evisceration of American medicine by a Republican-supported corporate takeover of health care. Given the rapid decline in the access to and quality of health care during that time, the American Medical Association (A.M.A.) should be fighting tooth and nail to reestablish patient care as the cornerstone of our health-care system. Instead, the A.M.A. has endorsed the Republican plan to reduce and essentially privatize Medicare and has entered into self-serving negotiations over the future of Medicaid, which is to be reduced to block grants to the states without national standards. The A.M.A.'s position will have terrible consequences for patients and physicians alike. It in no way represents my interests, to say nothing of my ideals.

The Republican bills for Medicare and Medicaid represent the final steps in an organized and ideologically driven plan to hand all of health care over to an exclusively profit-driven corporate system. What will soon become clear is that this corporate system in no way resembles a free market with built-in price and quality equilibriums. Instead we are getting a corporate oligopoly that robs patients of access to quality care and robs physicians of the ability to practice medicine based on autonomous professional standards. This is akin to having nationalized health care and immediately privatizing it. What we are left with is the worst of both worlds. We have neither the choice nor the quality that comes with a private fee-for-service system, nor have we the universality and security that comes with a national health-care program. No other industrialized country would tolerate so many uninsured, such limited patient choices, and such massive interference in clinical decision-making by a profit-oriented corporate health-care bureaucracy.

Instead of addressing this worsening health-care crisis from the perspective of the patients who are being denied quality health care, the A.M.A. has taken a narrowly self-interested view--focusing, unsuccessfully, on the protection of physicians' financial and authoritarian prerogatives. This attitude has long been a public-relations disaster--and is precisely why the A.M.A. has had so little real moral or practical authority during the health-care debate. In the current political environment, however, this approach has become truly dangerous for both doctors and patients. The only hope for reversing the current trends is a united front by physicians and patients demanding a system that promotes the best possible health care for the greatest number of patients. Instead, the A.M.A. has now abandoned the elderly and the poor to lower-quality health care in exchange for what amounts to a bowl of lentils.

Over the last year I was a fellow at the Freedom Forum Media Studies Center at Columbia University, studying the relationship of public opinion and media coverage on the health-care system. In my research I was struck by several interrelated issues. Most Americans are cynical about the medical profession, seeing it as greedy. They are angry at doctors for the lack of contact time and their poor communication habits. Physicians have continued to be insensitive to these problems, even as they've watched millions of their patients seek out alternative practitioners and pay out-of-pocket for unproven therapies, largely because these alternative practitioners are better at meeting patients' emotional needs. As a result of this lack of public trust, physicians played only a minor role in the health-care debate compared to the corporate representatives.

More important, most Americans were poorly informed during the health-care debate, and are confused about its outcome. Given the level of distortion during the debate, this comes as no surprise. The Republican rhetoric, corporate advertising, and A.M.A. public relations were misleading and confusing. Republicans such as Dole, Gingrich, and Elizabeth McCaughey were in perfect choral harmony with the insurance industry. …

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