The Washington Post
February 25, 2001
by Bill Brubaker
“Shortly after becoming chairman of Aetna Inc. last year, William H. Donaldson stood before a hostile audience of physicians and made a promise he has since repeated many times.” “…Donaldson said there would be ‘a sea change in our corporate attitude toward working with your profession.'”
William H. Donaldson, chairman of Aetna Inc.:
“We’re trying to bring some discipline to, let’s say, doctors… who send out for 25 tests or do things that are unnecessary. The medical profession has been taught in school that everything is okay. I mean: ‘Send out for 1000 tests. Do it.’ You know, with no attention to price control. No attention to the efficient and effective practice of medicine.”
“People want more than what they bought, the coverage that’s been bought. (They want) a $1 million experimental something or other. We say, ‘No, that isn’t covered by your policy.'”
Comment by Dr. Don McCanne:
William Donaldson recognized that Aetna had trashed both patients and physicians. His business acumen made him realize that, to be successful, Aetna would have to regain the support of patients and physicians, and thus his promise of a “sea change.” William Donaldson also knows that, as chairman, his first responsibility must be to the shareholders. He is obligated to look at the balance sheet and attempt to manipulate each side in order to increase the bottom line. He cannot escape his fundamental business instinct.
On the expenditure side, the problem is obvious to an astute businessman. Physicians spend too much and patients consume too much. So businessmen know where to place the blame for the problems with our health care system – on the patients and the physicians! So the proper business response is to control this reckless spending behavior. Even though physicians order only tests that are appropriate for the clinical circumstances, a good businessman will reduce this overhead expense by declaring some tests to be “unnecessary.” Even though patients expect help as long as any hope remains, a good businessman will extinguish that hope because it is “unaffordable” for the corporation. There is a fundamental cultural difference between the MBA and the MD. The private health plan model that controls our system today has placed the MBA in charge.
Is there a model that can put the MD in charge? After all, cost constraints will be with us forever, and the MD would have to function within these limits. What would happen if we were to change the primary mission of our health care system from the current business model of maximizing shareholder value to a public service model of maximizing allocation of our finite health care resources? In selecting tests for the patient, the physician would be selecting beneficial tests that would be limited only by the amount of resources available. There would be no arbitrary reduction of tests to fulfill the MBA’s duty to increase the bottom line. When the patient is looking for hope, the avenues available would be limited only by the existing resources and not by the MBA that wants to improve profits by dashing hope.
We need to nurture the partnership of the patient and the physician. We can do this by removing the MBA from the relationship, and by returning free choice to the patient. We can make accessible our health care resources to the limit of the full capacity of our system. We can do this by rejecting the private, middleman health plans, and by replacing them with a publicly administered, universal risk pool. Why on earth has this model been left off of the negotiating tables? Please tell me!
Don R. McCanne, M.D.
33781 Avenida Calita
San Juan Capistrano, CA 92675-4905