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Hard lessons for health policy

I would like to comment on some longer term issues that I think have been highlighted with the current crisis. In 1977 as a medical student, I went to a forum on health care reform in Washington DC when political momentum to change the system was high. A congressional staffer met with us and said that the existing system of private physician practices and non profit hospitals run by churches, local government, etc would not exist in the future. We(the future doctors) would either be working for big corporations or the government. As it has turned out, physicians work for both big corporations (the insurance companies, large hospital systems) and the government (Medicare and Medicaid). This hodgepodge has led to a very inefficient wasteful financing system and facilitated a small group of people skimming large sums of money from patients and taxpayers.

We have been on this path for 40 years and it is clear it is not working for the patients, healthcare workers, or country. I believe changing this path requires a change in the underlying concepts of this system. It is frequently referred to as the “healthcare industry” or the “healthcare market”. This promotes the idea that business people need to be running the system.

The current epidemic underlines the fundamental flaws of this thinking. Healthcare has a essential role in our society as do the police department, fire department, and schools. It should be structured with these functions in mind not on the profit margins of the companies or the business model of “just in time” delivery of critical supplies. How many healthcare workers will pay with their health or lives because of these failed concepts? How many patients?

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