The Hierarchy of Ends in Our American Healthcare System

What are the ENDS of our American healthcare system? Since the word, end, in this context means a goal or result that one seeks to achieve (The New Oxford Dictionary of English, Oxford University Press 1998), I guess it depends on whom you ask. I am going to list three rather obvious and important ends for our system, and I ask you to think about them and decide their relative importance, their rank in a hierarchy of ends:

  1. , the doctor  patient relationship, which is an equilibrium of trust developed between two people through which clinical decision making regarding the patient’s illness can occur,
  2. $$$$, which indicates a profit motive for the businesses which function within our healthcare system. These businesses include hospitals, health insurance companies, drug & technology companies, nursing homes, and on and on. Note that doctors’ practices are also included,
  3. Careers & employment, which includes doctors, nurses, technicians, administrators, malpractice lawyers, lobbyists for the healthcare industry, and many other types of positions, which somehow relate to our system of health care.

How do you rank their importance? What is the hierarchy of these ends? I believe that most doctors and patients would rank them in a certain order, while insurance company, drug & technology company, and hospital business people would rank them differently. And finally, those who are employed by our healthcare system might rank them in yet a different order of importance.

I suggest, since the citizens of the USA and some of the non-citizens provide every penny of the MEANS (money), which is the financial base making possible the existence of this system, that they be the ones who decide the hierarchic ranking of these ends. Then maybe a system, which truly tries to achieve the meaning of patient-centered care, i.e., sound, ongoing, non-conflicted, spontaneously functioning doctor  patient relationships, could be developed, as opposed to the “solutions” offered by the poisoned, agenda-driven, greed-driven rhetoric of ALL of our politicians.

How do you make something like this happen? Once they get elected, the politicians quickly forget who elected them, abandon the glorious rhetoric from their campaign messages, and sit in Washington, DC and in fifty state legislatures sucking off the government teat. Take a look at Jack Abramoff on the TV Show, Sixty Minutes,

How can we effect real solutions?

R. Garth Kirkwood, MD

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