TY - JOUR
AB - The seven years since the failed attempt of the Clinton administration to enact health care reform have seen the burgeoning of for-profit corporations in all aspects of health care. Giant health insurance and pharmaceutical corporations, for-profit hospital corporations with hundreds of hospitals, hemodialysis and nursing home chains, mental health and home care corporations, and many others less visible, such as quality-of-care and credentialing companies, are now well-entrenched in our uniquely American system of health care and are profiting handsomely. But in this free-enterprise free-for-all, how are patients—and doctors—faring? To find out, read this book. In the first eight chapters the authors undertake an in-depth critique of our corporate system of health care using mainly economic data and analysis. They examine the inefficiencies of private health care, profit-driven managed care, the health maintenance organization (HMO) scam, and pharmaceutical profiteering and demonstrate why the big business of medicine results in nefarious consequences for patients. An egregious example is investor-owned managed care: An HMO that provided excellent care for the expensively ill would risk attracting too many of these unprofitable patients, and face financial disaster in a competitive market. . . . Hence, HMOs have strong incentives to tailor their services to please the healthy, and to erect barriers to care for the sick. The authors expose such frightening practices as undertreating mental illness, inadequate rehabilitative care for stroke victims, and referring "heart surgery patients to the hospitals with the highest surgical death rates, presumably because those hospitals give the HMOs a price break." And the list goes on: medical bills causing nearly half of all personal bankruptcies, heaping financial hardship upon the suffering of illness; an insurance company deleting antitobacco messages from newsletters for subscribers at the behest of tobacco-company shareholders; higher death rates at for-profit hospitals; and more. In this corporate system the physician is a pawn manipulated by financial incentives of controversial ethics to bolster the bottom line. "Most managed-care plans engage in ‘economic profiling,' assessments of doctors' contribution to profitability, and base practitioner income . . . on these profiles," write the authors. "Capitation and bonus systems reward physicians who care for healthier patients. This pressures doctors to exploit patients' trust for financial gain." Later chapters contemplate a better system, borrowing heavily from our northern neighbors. Certainly not perfect, the publicly funded and administered system in Canada has not been fully able to carry out some of its five principles of universality, accessibility, comprehensiveness, portability, and public administration. Coverage of prescription drugs and home care, for instance, has been elusive, and attracting practitioners to remote places has been difficult.1 But Himmelstein et al do not have their heads in the sand. They fully recognize the shortcomings of Canada's single-payer system as well as its strengths. For example, they acknowledge queuing for certain specialized services, ferret out the truth from myths, and analyze the causes. Waits for radiotherapy are caused by a shortage of technicians. In the case of cataract surgery, "a small number of eye surgeons who operate in both public hospitals and private clinics have accumulated long waiting lists for public hospital patients . . . Thus, the availability of private care often undermines rather than augments publicly paid care." The authors present evidence to support their contention that Canada's is a better system. Comparative data regarding infant mortality, care of depression, and access to care are adduced. Life expectancy is two years longer than in the United States. There is free choice of doctors and hospitals without intrusive micromanagement of care while quality of care remains equal to that of insured US residents. And the cost per capita approaches one half that of the US system thanks to the absence of redundant bureaucracy, wasteful marketing, outrageous chief executive officer packages, investors' profits, and excess capacity. The authors also contrast the predicament of US physicians with their Canadian counterparts, most of whom are in private practice. Medical office administration is much less harassing in Canada thanks to the use of one simple billing form for all patients and prompt payment of claims. There is no interference in the doctor-patient relationship. The startling outcome is that physicians can "concentrate on medicine." And with little disparity in average physicians' incomes on either side of the border, "medicine has remained a highly respected and desirable career in Canada, attracting twice as many applicants per medical school place as in the US." Judging by the tone of the book, the authors clearly uphold US ideals of democracy and egalitarianism. While denouncing our present, untenable system of health care as "the bitter fruit of our rotten campaign-finance system," they affirm that "the US currently spends enough on healthcare to provide high quality, comprehensive care to all Americans." Despite wide popular support for universal coverage, the politicians' will to reorganize and reallocate our existing resources withers before the interested corporate donors. The authors use the format of grand rounds with slides of charts and cartoons as a substrate for each point. Each argument is clearly laid out and supported by data. The prose is well-phrased and easy to read and flows smoothly. Unfortunately, there is no index or consolidated bibliography. As advocates for our patients and to preserve the ethical underpinnings of our profession, all US physicians should read this compelling argument for medicine as a public service. References 1. Lewis SDonaldson CMitton CCurrie G The future of health care in Canada. BMJ USA. 2001;1609- 613Google Scholar
TI - Health Systems: Bleeding the Patient: The Consequences of Corporate Health Care
JO - JAMA
DO - 10.1001/jama.287.17.2289
DA - 2002-05-01
UR - https://www.deepdyve.com/lp/american-medical-association/health-systems-bleeding-the-patient-the-consequences-of-corporate-u00DPUa9WN
SP - 2289
EP - 2290
VL - 287
IS - 17
DP - DeepDyve
ER -