For-Profit Enterprise in Health Care (1986) / Chapter Skim
Currently Skimming:
1 An Exchange on For-Profit Health Care
1 An Exchange on For-Profit Health Care
Pages 209-223
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From page 209... ...
We have a crisis in the private sector because employers can't continue adding the rising costs of their employees' health insurance to the price of their products without becoming non-competitive in world markets. And we have a crisis in the public sector because the government, having made a commitment to provide care for the poor and the elderly, is no longer willing to pay the bills, and local taxpayers are unwilling to pick up the slack.
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From page 210... ...
in Japan, the bulk of health care is typically payroll financed. Collectively, German and French business firms bear a larger share of the nation's total health bill than do American firms.
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From page 211... ...
Rather, I am referring here to central tendencies, to the mainstream of American medicine as it has revealed itself through the ages to a paying public. What then, in the conduct of mainstream American medicine should have led a thoughtful person to expect from physicians a conduct distinct from other ordinary mortals who sell their goods and services for a price?
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From page 212... ...
Principles of Medical Ethics include the following tenet: Physicians are free to choose whom they will serve. Further on in the piece the author opines that "an AMA legal analysis states that 'a physician is not required to accept as patients all who apply to him for treatment.
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From page 213... ...
Incidentally, I am not saying that the medical profession departs from He celebrated Hippocratic Oath our medical graduates swear. As I read that oath, I see no reference in it to charity care.
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From page 214... ...
Would you not agree that, given the entrepreneurial practice setup American physicians have always preferred, and given the pressure on physician incomes likely to come from a physician surplus, this disparity in hourly remuneration may lead to needless testing, hospitalization, and length of stay, even if all hospitals in our country were not-forprofit? I put to you the proposition that this question goes to the heart of our debate.
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From page 215... ...
In that scramble, medical ethics may be bent. I hold to the proposition that it matters little if those who scramble for health care dollars define what they grab as "honoraria," "income," or "profits." These are semantic differences of little practical import for, when faced with economic extinction, nonprofit enterprises are unlikely to fight nicely nor, I suspect, will unsupervised, self-employed, fee-for-service physicians.
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From page 216... ...
Unfortunately, you have avoided a direct answer by inveighing against the moral hypocrisy of the medical profession. You seem to be saying that since there are so many profitoriented entrepreneurial physicians out there, and since "the ethical standards by which our health care sector operates will ultimately be driven by the ethical standards of our physi ,, ~ .
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From page 217... ...
They boil down to the question of whether there is something special about health care which makes distribution of health services in a commercial marketplace problematic and inappropriate. A second issue (or set of issues)
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From page 218... ...
In your paper you take issue with premises underlying the emerging pattern of capitalist medical practice in this country. As I interpret your policy recommendation on pages 17-18, you argue that physicians should not enter joint ventures with other entities in the ownership of health-care capital and, presumably, that they should not own expensive medical equipment as sole proprietors either.
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From page 219... ...
In a paper he prepared for last year's Duke University Private Sector Conference on Health Care, for example, PICA chairman Don MacNaughton argued explicitly against joint cooperative economic arrangements between hospitals and physicians. Don seemed worried that, in the long run, such joint ventures might impair the image of the hospital industry.
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From page 220... ...
The second question is a purely empirical one. The champions of free markets in health care obviously are persuaded that individual patients can muster adequate countervailing power even against systems in which the physician's and the hospital's economic incentives are fully aligned against the patient.
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From page 221... ...
You think that investor-owned hospitals are compatible with the strict code of medical ethics I espouse because "as long as physicians can keep their noses clean of economic conflicts of interest in their role as the patients' agents, they should be able to act as their patients' powerful ombudsman in dealing with institutions." I agree that physicians must avoid conflicts of interest if they are to represent their
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From page 222... ...
As with your earlier opinion about the role of private capital markets and physician entrepreneurial ownership of health care facilities (page 2) , I believe the issue hasn't been discussed or analyzed sufficiently to say what the American people really do believe.
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From page 223... ...
And in decrying entrepreneurialism in investor-owned hospitals, I also decry similar behavior by voluntary hospitals and among physicians. I am frank to admit, however, that I am not sure what the best alternative would be.
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