Monday, March 09, 2015

Health Care Run by Those "Who See the Practice of Medicine as a Set of Economic Transactions," or as a "Moral Endeavor?"

Calls are getting louder for restoring medicine and health care as a calling that puts patients first, versus a business that puts money first.  For example, in the conclusion of her opening talk for the 2015 Lown Institute Annual Conference: the Road to RightCare, Shannon Brownlee said, [with italics added for emphasis]

So today I stand before you not as a writer turned health policy expert turned health care activist, though I’m still all of those things. I stand before you as a mother, a wife, a daughter . . . and a citizen. I stand before you filled on the one hand, with dismay . . . and on the other hand with a full measure of hope. I stand here to welcome you to the work we are all doing to transform healthcare.

And our first step is to name our task. It is not just stamping out overuse, though we must do that. It is not just ensuring that patients get the care they need. Though that is unfinished business.

Getting to the right care also requires that we recognize the historic choice we face between opposing world views. On one side are those who see the practice of medicine as a set of economic transactions, and healthcare as just another business. This side thinks the market solves all ills. This side sees the health professions as the labor needed to run a highly profitable industry. You are the 'providers' of services -- the help. Patients are revenue. Excuse me, 'consumers.'

On the other side of this divide are those who see healthcare as a moral endeavor. This side seeks to serve both patients and the common social good. This side knows that ignoring the patient as vulnerable human being is the quintessential failure of our system. This side acknowledges our need for hospitals, and for companies to manufacture drugs, and devices, and scalpels and surgical gloves. But the delivery of healthcare should not be designed for their benefit.

If we want to get to the right care, we must begin to envision a vastly different system. A just system. A system whose purpose is to serve patients and communities. A system that is not just reformed, but radically transformed.

The purpose of this conference, the reason we are all here today, is to find our way towards that transformation.
[The above was reprinted with Ms Brownlee's permission.]

On Health Care Renewal, we have long been showing the consequences of health care run by generic managers who believe the business school dogma of promoting "shareholder" value, even when their organization has no shareholders, by putting short term revenue ahead of all else.  They are backed by market fundamentalists who believe all of human life can be reduced to business transactions.  The results have been very profitable to some, particularly to the very same generic managers, in terms of every rising executive compensation untethered to any clear evidence for these managers' achievements, beyond making money.  I have suggested that this has become a major cause of health care dysfunction, of ever rising costs, shrinking access, and threatened quality.  True health reform, or transformation, to use Ms Brownlee's term, would restore the priority of patients' and the public's health, and return health care to those who see it as a calling, not just a way to get rich. 


Judy B said...

Bravi to both of you! My hope is that something gets done to turn the medical care industry around. My fear is that the entrenched powers are too strong for that to happen...

Don Levit said...

The Bible mentions money as the second most talked about subject.
Obviously, money has a moral component inherent in its very nature, and needs to be approprtiately honored in decision-making.
Don Levit

wiley said...

It's amazing how much influence the Harvard Business school and their pet management theories have on academia and mainstream culture, from medical care to what is and is not considered a good character trait.

Unfortunately, a lot of those theories get buried in texts and classrooms without attribution so that someone with a 101 background in anthropology, for instance, can be led to accept some silly management shibboleth as if it were a universal truth about humans delivered via a burning bush.

Susan Molchan, MD said...

Steve Nissen from Cleveland Clinic summed it up: "Our profit driven system is all about people making money from illness.” But the Lown conference was great in showing success stories of people who truly focus on health-- of hospital administrator Dr. Patricia Gabow, of Dr. Mitch Katz, of Dr. America Bracho; and in showing a way forward: "Organizing for Change." So much covered; I'd encourage everyone to catch what they can of it online, or to attend next year.