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Editorials

The American Health Care System and the Role of the Medical Profession in Solving Its Problems

Department of Cardiovascular Surgery, Children’s Hospital Boston, Boston, Massachusetts

^_* Address correspondence to Dr Mayer, Department of Cardiovascular Surgery, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115 (Email: john.mayer@cardio.chboston.org).

The first 300 words of the full text of this article appear below.

In the current issue of The Annals, two opposing viewpoints [1] are presented on the optimal organizational structure for health care insurance in the United States. Himmelstein and Woolhandler argue that a single-payer national health care insurance system would solve many of the current problems in financing, access, and delivery of health care; whereas Goodman suggests that reform should remove the current private and public health insurance third-party payer structures from the equation to promote competition among providers on price and quality and restore the doctor-patient relationship. I agree with both Himmelstein and Goodman that reimbursement may be at the root of many of the problems that the American health care system is facing. However, neither of these authors’ proposals would engage the medical profession in providing solutions, even though physicians’ pens and keyboards are still ultimately responsible for much of what American society spends on health care.

Historically, members of a profession have had a number of important prerogatives and societal responsibilities, which include adhering to a code of ethics that includes the moral imperative to serve others, advancing a body of knowledge and transmitting it to the next generation, setting and enforcing its own standards and values, and cherishing performance above personal rewards [2], self-regulation [3], and fairly distributing finite medical resources [4]. Gruen and colleagues [4] recently noted that physicians have a "responsibility to address the rising costs of health care, which are a key threat to access." A conceptual model of the relationships among the professions, market forces, and society has been proposed by Krause [5]. He describes the privileges and prerogatives of the professions as inherently in conflict with the forces of the free market, but notes that these "anti-market" privileges are . . . [Full Text of this Article]

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