Socialized Medicine and Healthcare Reform: The Relationship Between Doctor and Patient Must Achieve Autonomy From All Payers

The following three references were used for information for this post:

  1. The New Oxford Dictionary of English, Oxford University Press 1998

Socialized Medicine indicates the provision of medical and hospital care for all by means of public funds.

Socialized Medicine refers to a health system in which the government owns and operates both the financing of health care and its delivery.

What does this mean for the people living in a country, in which these definitions apply? It means the government of that country can strongly influence and control how medicine is practiced there.

Wait a minute! What about the doctors and the patients? The doctors are supposed to be practicing medicine within the context of the doctorpatient relationship. This relationship is between the doctor and the patient; the government has nothing to do with it. When the government employs the doctor, it has everything to do with it. The government can end the independent functioning of the doctorpatient relationship. If you think this potential control and interference is good, then this type of health system is just right for you.

What about in America? We don’t have socialized medicine here, do we? Our nation’s V.A. health system, reserved for our veterans, is the purest form of socialized medicine.

Our Medicare system, although often decried as “socialized medicine” and funded in significant amounts by general tax revenues, is a form of social insurance, coupled on the healthcare delivery side with a mixture of government-owned facilities (e.g., municipal hospitals), private nonprofit hospitals, and private for-profit facilities. Medicare was originally established as a single-payer, government-run, fee-for-service plan; however, starting in the 1970s, Medicare beneficiaries have had the option of enrolling in a variety of health plans offered by private insurers. So, our Medicare system is not, strictly speaking, socialized medicine. Yet, our government still has huge potential for influencing the practice of medicine for Medicare beneficiaries.

Well then, we just can’t have a “Medicare For All” system in America. That would mean government control. We need to stick with private insurance carriers. The private insurance carriers as what, what is their job? They attempt to control the doctorpatient relationship like government payers do. They view doctors as employees, the doctorpatient relationship as a tool to drive their profit, and their own business accomplishments as the definition of health care. What they should be doing is the simple clerical duty of paying claims. However, by complicating this with tedious, cunning business manipulations, they have evolved light years beyond this simple, clerical function into mega financial empires.

It boils down to a simple question: Who is the doctor’s employer? Is it the government; the private insurance carrier; a health plan; some combination of these; or, beyond commonsense understanding in our current milieu, could it be the patient? Wonderful healthcare reform will not ensue until the ethos of the American healthcare system becomes identical with the reality that sound, ongoing, non-conflicted doctorpatient relationships must be the primary goal to be accomplished for everyone living in America; that these relationships are employee—employer relationships; and that all healthcare businesses exist primarily to serve these relationships and not their own profit goals, which, although necessary and important, must be assigned to a secondary rank.

This employee—employer relationship is, to be sure, an unusual one in that the employee, the doctor, retains autonomy. He/She does not do what the employer, the patient, tells him/her to do. The doctor, based on his/her medical training and experience coupled with information from the patient including patient preference, develops a plan of diagnosis and treatment. The patient can accept or reject this plan and works with the doctor to develop a way forward, which is individually suitable for himself/herself, while the doctor guides the relationship to accomplish what is necessary for each circumstance of the patient’s illness.

Health insurance companies make significant efforts to influence this relationship with concepts such as: financial incentives for doctors and patients, managed care, information sharing, medical home, cost effectiveness, evidence-based medicine, and on and on. New ideas continue to evolve to manipulate the doctorpatient relationship, because this is where the money is spent, i.e., where clinical decision making regarding diagnosis and treatment occurs. Thus, if insurance carriers can manipulate the doctorpatient relationship, they can control the money. This control is not altruistic in nature, not for the benefit of individual patients or for our country, but rather for lining their own pockets. Unrelenting increases in premiums and deductibles further this cause.

When the general public understands that insurance carriers’ attempts to influence and control the doctorpatient relationship are the same thing as attempts to control it by government payers in socialized systems beyond our borders (e.g., England, Canada), maybe they will come to the realization that true healthcare reform cannot occur until the doctorpatient relationship itself gains autonomy from all payers. Until then, enjoy the rhetoric and propaganda put forth by politicians, pundits, and the healthcare businesses, which support them.

R. Garth Kirkwood, MD

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