On Medicine and Money
By Eli Y. Adashi, MD, MS
JAMA Forum, April 30, 2014
As might have been anticipated, much of the media coverage of the release of the CMS data focused attention on health care professionals dubbed “Medicare millionaires” and their practice patterns. Tantalizing as such details might be, more profound issues were being sidestepped. In particular, little has been said with respect to the uncomfortable relationship between medicine and money.
This is an unfortunate state of affairs, because the ethical and moral challenges associated with the juxtaposition of medicine and money are highly deserving of our attention.
Many see the pairing of money and medicine as a nonissue, and instead view it as capitalism at its best, with medicine being just another market in which competition reigns supreme. For proponents of this point of view, health care professionals might be seen as operatives in a retail business, wherein the volume of sales (of health services) carries the day, creating a vibrant health care market that sparks the scientific innovations upon which we have all come to depend. They see the business model of medicine as no different than that of any other field of pursuit, naturally rooted in foundational libertarian principles. Viewed in this light, the intersection of medicine and money is as American as apple pie. Exemplified by the time-honored “private practice” of medicine, this all-out embrace of the business principles of a market economy remains undiminished—if increasingly untenable.
But there’s a potential flaw in this line of reasoning: the presumption of a fail-safe firewall between financial considerations and clinical decision making. Sadly, that may not always be the case.
Clearly, opinions vary widely as to the ethical and moral wisdom of mixing medicine with money. Some would favor a lightly regulated, self-policing field, wherein unfettered entrepreneurship and Medicare millionaires are bound to thrive. According to this outlook, infractions perpetrated by a select few do not warrant the imposition of blanket, heavy-handed oversight.
But those who consider medicine and money to constitute a volatile mix may express preference for another model, such as a national health care system buttressed by a single governmental payer, in which value rather than volume of services determine provider compensation. Under this system, Medicare millionaires are unlikely to flourish.
JAMA Forum: On Medicine and Money
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Comment:
By Don McCanne, MD
Physician. Seeing that word, what comes into your mind? Do you think of a person who is dedicated to promotion of health and healing of the sick? Or do you think of an occupation that is as American as apple pie in its dedication to retail business within the entrepreneurial health care marketplace?
Medicine is different. Those favoring unfettered entrepreneurship with the chance to become a Medicare millionaire really do not belong in the field. Most physicians find the imposition of money considerations into the relationship between the physician and the patient to be a great nuisance, if not outright repulsive.
Dr. Adashi reminds us that there is another model that would be preferred by most physicians who would rather be healers than entrepreneurial businessmen. That preferred model is “a national health care system buttressed by a single governmental payer.”
Isn’t it time for us to change our model?
