The VA Health System, the American Health Care System, and the Doctor—Patient Relationship

The VA health system, the purest form of socialized medicine, and the American health care system, a hodgepodge of private & public 3rd party payers coupled with individual out of pocket spending to a myriad of health care businesses, both show signs of disturbing core difficulties as evidenced by the current VA investigations and the Affordable Care Act.

Why is it, do you think, that there are so many problems across the entire spectrum of health care in the USA? Is there a common denominator for all the problems?

The common denominator is that none of the systems of health care in America actually promote health care. They promote political footballs; vote-getting agenda driven rhetoric; administrative job creation in local, state, and federal government; big pay days for health care administrators; and fodder for the news-television-radio media. But actual health care, who cares?

WELL!   What is a really good health care system? A really good health care system is one that achieves clear and equal access to sound, ongoing, non-conflicted doctorpatient relationships in an affordable manner for everyone living in America. This cannot happen in our current environment. It won’t happen until the doctorpatient relationship is freed from the influence of any 3rd party payer of doctors’ salaries  & bills or of other additives to doctors’ personal income and until all the doctors and patients step up to the plate to recognize, understand and accept the responsibilities of their own unique doctorpatient relationships.

The doctorpatient relationship is a hothouse flower and must be regarded and treated as such by everyone including doctors and patients themselves. It’s this relationship, this equilibrium of trust, which defines health care, not the doctors & patients nor any one or group of human beings involved in health care.

Until this relationship is removed from the clutches of the dollar bill administrators, including those at the VA health system, health insurance companies, and government 3rd party payers like Medicare & Medicaid, our health care system will continue its downward spiral into a lush dollar-green grazing range populated with politicians, huge numbers of administrative personnel, and CEOs of the various health care businesses chowing down on the roughage and with patients herded into defined, barren (devoid of proactive advanced specialty thinking and intervention) holding pens never to be heard from again–except of course in the cases of the politicians themselves, who immediately call for and receive the most advanced specialty care available for their individual ailments.

How can we free the doctorpatient relationship from the administrators’ dollar bill stranglehold? The Senators and Representatives in our Congress functioning as true servants of the people (an old idea but completely new concept for them) create a central payer legislation, which separates the business of medicine from the medicine of medicine; demands sensible healthy (not greed-driven) profit for the necessary health care businesses; and demands that the equilibrium of trust between the doctor and the patient function and evolve as it must for each individual case without interference from budget managing administrators who create career advancement and bonuses based on a counter-intuitive concept, cost control.


R. Garth Kirkwood, MD