Thursday, May 1, 2014

Fwd: qotd: Medicine and Money

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-------- Original Message --------
Subject: qotd: Medicine and Money
Date: Thu, 1 May 2014 09:50:44 -0700
From: Don McCanne <>
To: Quote-of-the-Day <>

JAMA Forum
April 30, 2014
On Medicine and Money
By Eli Y. Adashi, MD, MS

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.


Comment by Don McCanne

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?

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