To the Editor:
Professor Herzlinger's editorial "Who Killed Healthcare?" lays the responsibility for the healthcare mess in the laps of those to whom it belongs -- for the most part. However, I think she exempts physicians from creating some of this problem for themselves. Clearly individual physicians are not responsible for the dreadful mess of US healthcare, but to deny their collective responsibility does us absolutely no good in finding a solution.
It is unfortunate that some physicians feel they can no longer practice medicine, but most things I know of can no longer be done in the way they used to be. For the most part, in order to practice medicine one has to be in the business of providing medical care. Providing medical care is a business, and if you chose the small business option, it is like many other small businesses: very hard, and not everyone can (or wants to) follow this road. The pressures on all small businesses are intense, but in my state physicians (and other specified healthcare practitioners) can deduct around a 6% gross receipts tax on a large part of their earnings that the majority of the rest of us have to pay, so in that regard they are getting off very easy.
One aspect of not being able to practice the old way is the high cost of medical malpractice insurance, which can be a killer; but please let us remember the AMA's public relations to portray physicians as omniscient (think Ben Casey's carefully orchestrated image). If the public perceives you as omniscient, then why should they be tolerant of mistakes? Physicians are human -- admit it -- and everybody's lives will be a bit easier.
Although the majority of physicians do not belong to the AMA, it is an organization that is perceived to speak for physicians and it has a history of opposition to any type of public payer healthcare system. A publicly funded healthcare system may not be the type of system we want to adopt, or will adopt, but an inflexible opposition to discussing the options is not going to get our nation ahead.
There are also treatment approaches physicians might take even within the present healthcare system to retake the initiative, yet they appear loath to do so. An example is the enormous human and dollar toll of substance use. Physicians have been shown to be capable of directly working with their patients in combating this disorder especially in the early stages. Patients would benefit because many co-occurring medical disorders would drastically decease, and physicians would benefit by claiming new ground in treatment and disease prevention. However, physicians have not wanted to take this bold new step.
I have been involved as a business owner and also as a clinic director in trying to get insurance companies to pay for behavioral health services. It is sometimes a truly horrible experience, and there is no reason why that should be -- perhaps other than just pure meanness. I think it would be great if physicians would stand with consumers and demand that we have a responsible healthcare system, but for that to happen I think there needs to be some attitude and behavior change.
Verner S. Westerberg, PhD
Albuquerque, New Mexico
Herzlinger RE. Who killed healthcare?. MedGenMed. 2007;9:50. Available at: https://www.medscape.com/viewarticle/561897 Accessed October 29, 2007.
I applaud Dr. Westerberg. Those are wise and helpful sentiments.
Physicians have been complicit in their own problems, of course, and they must be proactive in addressing issues of outcome transparency; but the physicians cannot and should not bear responsibility for the problems of healthcare. After all, they are the primary agents for delivering it!
We can and should have a universal coverage system, but we should do it with the consumers and doctors in control, as in Switzerland, and not with the government in charge, as in the United Kingdom and Canada. (See chapters 8-10 of Who Killed Health Care? by Regina E. Herzlinger; McGraw Hill, 2007).
Professor, Harvard Business School
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