Leadership Responsibilities and Integrity of Physicians in Healthcare

Antal E. Solyom, MD, PhD, MA

Disclosures

Glaring inequalities and injustices have left large segments of our population uninsured, underinsured, or unreliably insured. According to the January 14, 2004 report by the Institute of Medicine,[1] about 18,000 inexcusable deaths are due to lack of health insurance in our country every year. It is as if the human toll of 9/11 had been devastating those among us who have been deprived of health insurance roughly 6 times yearly!

This state of affairs is morally abhorrent for 2 additional reasons. First, more than a half century ago, in 1952, the President's Commission on the Health Needs of the Nation stated that "Access to the means for the attainment and preservation of health is a basic human right [italics added]," and that "The same high quality of health services should be available to all people equally." Second, during this same time period, all developed civilized societies have recognized that healthcare was a human birth right, and have established equitable basic healthcare provisions for all their citizens. Yet, our most affluent and technologically developed society has failed to confront the fundamental moral problem of unrealized rights and unattained justice.

"Where Have We Failed?" asks Roger Howe aptly in the title of his book on the patchwork nonsystem of US health care.[2] Although he seems to aim the question at society at large, we, physicians, have to admit that we have failed collectively by allowing our noble vocation to become part of a healthcare industry, and the healthcare of our compatriots a mere commodity on the market place. Have we shortchanged only our social responsibilities or our integrity as well?

The American Medical Association convenes the 2004 National Advocacy Conference this month to emphasize the importance of healthcare in the 2004 election campaigns. This may be a test of the moral leadership of our profession on behalf of just healthcare for all. In support of the latter, my thesis is that there is an implicit, prerequisite right to healthcare that is integral to the inalienable rights to life, liberty, personal dignity, and the pursuit of happiness. In other words, I consider it self-evident that adequate (not exceptional!) physical and mental functioning is fundamentally important for a respectable, dignified, satisfying, and productive human existence. Because of its ties to inalienable rights, healthcare cannot be alienated like material possessions, and it is unethical to sell and profit from healthcare on the market place as if it were a commodity.

Accordingly, our profession should speak up against, and avoid being part of, the manipulation and exploitation of people's healthcare by for-profit insurance companies, HMOs, and managed care organizations. Instead, we should reaffirm our moral standing as healers serving individuals and society via a nonprofit delivery system (whether with a single or double payer administrative arrangement) that ensures equal access and quality of healthcare for everybody, whether member of Congress or unskilled laborer. In a government-guaranteed (not necessarily government-run) universal system, physicians could still provide fee-for-service care to patients, and with much less extraneous hassle than the currently estimated 40 minutes every day.[3,4] It has been well documented that a simplified uniform administrative system would save more than enough money to provide full coverage and prescription benefits for everybody within the limits of current healthcare expenditures.[5]

It is time that physicians demonstrate moral fortitude in advocating through all relevant governmental, academic, and organizational entities for the above radical transformation of US healthcare, and for interim emergency measures, so that the current carnage can be stopped as soon as possible.

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