Someone once told me that the difference between the care your pet receives and that of someone enrolled in an HMO is that the person paying for the pet’s care actually cares about the pet. Funny, but tragically, true. The veterinarian has the best interest of the pet in mind. The HMO board or medial director has something else in mind. Whatever it is, it is not the patient. This is an incredibly important departure from what is considered the traditional doctor-patient relationship. This important relationship champions the individual. Period. Not the collective. Not society. Not the HMO stock holders. Not the taxpayers. Not the environment or upper atmosphere. It is no coincidence that this consideration of the individual was jettisoned for the larger impact on the collective in Bismarck’s Germany in the 1920′s. The birth of national health care in Germany made any man’s illness every man’s problem. This predictably led to limits on what would be treated, as the collective masses were actually better off economically to let the sick die.
This mob rule of the sick is the scariest part of any national health care plan. If you are sick and are a drag on society and are of no use to “the state” then the mob is better off without you and this or that medicine or procedure you need might not be available. OK. Let’s try this if you aren’t following me so far. Your child is sick. Some stranger in a suit in the hospital tells you that they have done an economic calculation and saving your child simply isn’t cost effective. Think this can’t happen? It did happen in Germany.
Many physicians have fought and resisted this vicious twist in their patient relationships. This resistance has taken the form of severe financial hardship at times when the corporate medical types have tried to crush the hold-outs by excluding them from “the network” or actually hiring salaried competitors. These primary care doctors are heroes in the truest sense. They are battling for the very lives of the patients in their care. They have not sold out, sticking instead to the principles embodied in the oath all physicians take. Others have surrendered under the most hostile conditions, working within the system for the benefit of their patients in spite of threats and consequences like sham peer review and medical board water boarding. Some (the Vichy doctors) have run to Darth Vader as soon as he appeared to find out how they can help him.
If your physician treats you and your family like individuals, slaying medical dragons in your best interest, in spite of the hostile environment we work in, you have a champion like no other. If, on the other hand, your doctor ever says “… things other than what’s best for you must be considered..”…or some version of that….find another doctor. The fatal conceit has infected him and he will not likely recover.
G. Keith Smith, M.D.
