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Ann Thorac Surg 2000;70:351-353
© 2000 The Society of Thoracic Surgeons

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Editorial

Medicine at the turn of the century

^a Distinguished Professor, Tufts University, Boston, Massachusetts, USA

Address reprint requests to Dr Kassirer, 150 Hickory Rd, Weston, MA 02493

The delivery and the cost of health care are once again the focus of great public attention. The defeat of the Clinton health-care plan in the 1990s initiated the fastest and most sweeping changes ever in our health care system. Although the plan was conceived in idealism with an intention of providing universal coverage, it went nowhere, in large part because of the political ineptitude of our national leaders and the lobbying efforts of the insurance industry. In the process, government has essentially been eliminated as the prime mover in the organization of health care in favor of a massive experiment in which private health-care markets now deliver and manage care. Many involved in this conversion simply consider health care a marketable commodity.

The changes in health care delivery over a few short years have been remarkable. The familiar model of one-on-one patient-physician care in solo practice has been replaced by large physician groups, massive integrated systems, and huge for-profit hospital and insurance conglomerates. Numerous new stakeholders have emerged, including health care lawyers, consultants, advertising agencies, and for-profit entities.

Those who tout the benefits of the market takeover of medicine fail to point out that in medicine, the market is far from perfect and that this conversion has led to many untoward consequences. A major manifestation of market failure is the growth in the number of uninsured and underinsured people in the United States, now representing more than 44 million Americans. Medical education is threatened. Academic medical centers, which have been under siege financially for years, are facing serious deficits. Some of these centers have already made deals with the for-profit sector to bail themselves out of massive debts, and some have even gone bankrupt. Vertical integration, a strategy that was never based on empirical observations, has faltered, as have . . . [Full Text of this Article]