Rich Man Poor Man Healthcare Reform Principles: Clinical Need Not Ability To Pay

That medical care is based on clinical need not on ability to pay is the third core principle for sound healthcare reform for the USA. If a rich man and a poor man have the same illness but the poor man has no insurance, is it right that the rich man can easily receive advanced medical evaluation and treatment, since he has good insurance and plenty of cash to spend, while the poor man can’t even contemplate going to the doctor? The poor man may wind up going to the emergency room, from which he can’t be turned away, but this is totally different than an ongoing doctorpatient relationship with an experienced specialist.

It is certainly right that the rich man can avail himself of the best diagnostic and treatment modality available through a sound, ongoing, non-conflicted doctorpatient relationship. But, in my view, it is not right that the poor man cannot, because of lack of financing. Becoming part of an entitlement population, whose medical care is paid by public funding (e.g., Medicaid), does not change this fundamental inequity. Entitlement populations become quickly disenfranchised because public funding for payment is less than private payment.

Can healthcare reform change this fundamental human behavior? I don’t know. But it can completely remove the economic reasons for its existence by creating a payment mechanism, which yields the same (fair and adequate) dollar amount paid regardless of whether the patient is rich or poor. Thus, doctors would have no economic excuse for not seeing patients, who, in the current system, couldn’t come close to paying the bill. The reality of huge overhead expense in private practice, not under doctors’ control and put into place by administrative paperwork from both private and public payers and by American society itself, because of its need to blame somebody, its need to be litigious, causes significant financial struggle. When a large proportion of patients in a practice come from an entitlement population, these financial pressures can become overwhelming.

America’s healthcare reform should absolutely end this financial dichotomy, created by the business of medicine’s quest for the dollar bill. In that way, the system can fulfill this third core principle: Based on clinical need not on ability to pay, which would make the business of medicine subservient to the medicine of medicine, the absolutely correct pecking order for our healthcare system.

R. Garth Kirkwood, MD

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