Soon, our doctors will be corporations, or working for them, if they aren't already. Profit is becoming the driving force behind the American medical system, and no good can come from this.
Medicine is changing from a patient-centered, caring universe of physicians, nurses, health professionals, and community-oriented hospitals -- singularly devoted to prolonging and enriching human life -- into an industry offering the affluent few an opportunity to draw handsome profits from the sicknesses and misfortunes of the many. Do you think the owner of a few shares of Humana or American Hospital Corp. will take any more interest in the human services his hospitals are providing than in the performance of the oil company or meat packer whose shares are also in his portfolio?
What happens to the spirit of a community when the hospital in which so many people have invested so much money, time and voluntary service is swallowed up by a remote, profit-seeking corporation?
The commercial spirit and ethical tone of America's big business community today leave no room to doubt that the commercialization of our medical institutions and ultimately of the profession will degrade the quality of care and compromise the integrity of the profession.
In a recent Patient's Advocate columnn, Victor Cohn raised the specter of "Medicine, Inc." To bring the issue closer to home, ask yourself, "Will my doctor, working in the new commercial world of medicine, really care for me?" Or will he, like any other smart and loyal employe in a sharply competitive industry, be concerned first of all to cut costs and services, to boost earnings for his branch of "Medicine, Inc."?
One wonders how the medical profession ever got euchred into this commercial game. Who ever heard of doctors having to "market" their services? After all, they aren't hurting for money, serving patients privately, as most do, on a one-on-one, fee-for-service basis, and with about 90 percent of their billings guaranteed or paid by third parties -- government or insurance plans. They ultimately control the production, licensure and practice of their colleagues. And medicine, as a calling, ranks topmost in public esteem.
Physicians originated the hospital as a center where all the skills, resources and apparatus of the health professions and the community could be assembled and coordinated to the single objective of curing the sick and healing the wounded. To superimpose an imperative to earn profits for an absent party will inevitably require physicians to accommodate their practices, in admission, treatment and management of patients to an extraneous and inappropriate consideration. And they are ethically bound to resist this pressure.
The "health care industry" -- as an investment entity -- comprises a substantial number of investor-owned corporations, some of them very large, most growing rapidly by aggressively acquiring or contracting to manage hospitals and nursing homes. About 80 percent of U.S. nursing homes and perhaps 20 percent of hospital beds are owned or operated by these corporations.
Eighty percent of these chains did not even exist before the mid-'60s, when the great federal medical care entitlement programs were launched.
In tune with current corporate folkways, these corporations have begun to gobble one another up in a fever of mergers and combinations. Some are also candidates for merger with massive conglomerates, which are strangers to the mission and structure of medicine.
The most serious current problem for hospitals is the financing of care for the "uncompensated" patient -- the estimated 30 million or more of us who have no funds or insurance to pay for medical care. Nationwide, public hospitals spend 11 percent of their gross patient revenues on these "charity" patients; private for-profit hospitals, 3 percent. Despite state laws nearly everywhere requiring hospitals to admit and treat any patient requiring emergency care, for-profit hospitals regularly "dump" uninsured patients on the nearest "charity" hospitals, thus tightening the financial screws.
By the end of the century, Cohn and others predict that as few as 20 huge corporations may be providing medical and hospital care and health insurance for six out of 10 Americans.
What meat doth this Caesar of an industry eat, that he has grown so great, so soon?
After World War II, the public built or rebuilt the nation's hospital plant. During the past 30 years, we have financed, largely through the National Institutes of Health, more than 90 percent of all health research in the United States, producing most of the "miracle drugs" and the fantastic diagnostic and therapeutic technology our physicians use today. In 1965, we enacted Medicare and Medicaid, which provided, virtually overnight, fully financed access to medical care for millions of aged and disadvantaged Americans unable before then to pay for needed care.
And now all this public largesse, all this social investment in a beneficence we declare to be a basic human right in our democratic society, is being turned over to a comparative handful of investors and speculators.
American medicine belongs to all the people; it was created by all the people; it is dedicated, by the profession itself, to the service and needs of all the people. It is the ultimate naivete' to expect a local hospital to act like a local community service when it is owned and dominated by one of several giant corporations in deadly competition with one another, or, more likely, themselves absorbed into enormous conglomerates whose components are all lashed to the bottom line.
Will you -- with a straight face -- be able to call him or her "your doctor," when he examines you "by courtesy of 'U.S. Medicine, Inc.' "?