The three proposals receiving the most attention are the Clinton Plan, managed competition, and single payer. The Clinton Plan would force all but the most fortunate citizens into government-controlled, bureaucratic health-care cartels. Managed competition, sponsored by Rep. Jim Cooper (D-Tenn.), is similar to the Clinton Plan but without price controls. The single payer is a Canadian-style government monopsony that forbids patients to pay directly for medical care. All are attempts to turn back the clock to failed systems like mercantilism and socialism, while the rest of the world (even Sweden) progresses toward privatization. Their vision is a nationalized health-care system, marching regularly in lock step under the direction of a central monolith. (The monolith, they imagine, will be under the direction of themselves and their buddies.)
People may swallow the deadly "health" potion because they have forgotten what medicine is about.
Medicine is about healing the sick and the injured. The heart of medicine is the relationship of one doctor to one patient. The \o7 patient \f7 is at the center of the universe. Not the "health-care delivery system" and its ruling bureaucracy. Patients don't march in lock step. Every one is unique.
When I see a patient, my job is to think about how to help that patient. Not to build a brave new world, or to save the planet, or to fight the War on Drugs or the War on Poverty or the War on Crime, or to save money so that the health plan managers can have a fancier cellular phone, or to achieve a set of social priorities that may require the sacrifice of that one patient.
WHEN I APPLIED TO MEDICAL SCHOOL, I WAS A FAIRLY typical candidate. I said the right things at my interview, like all the other applicants ("I like science, and I want to help people"). I had engaged in an extracurricular activity (debate team). But most important in the early 1970s, I had good, non-inflated grades.
Medical schools are now having second thoughts. Admitting people like me was evidently a mistake. The idea is to build "a new kind of doctor for the 21st Century," in the words of former Surgeon General C. Everett Koop, now senior scholar at the C. Everett Koop Institute at Dartmouth College in New Hampshire, but more visible recently as an unofficial member of the Clinton plan entourage. His New Doctor is portrayed as a patient-friendly family physician.
Koop would change medical school curricula to prepare New Doctors, making them, for example, computer literate. But if this idea "doesn't catch," he told one reporter, he is prepared to "just push it."
The New Doctor is supposed to be full of humanitarianism and empty of greed. I do not know how to identify such a person in advance. All the aspirants that I interview for our local medical school seem to be nice, idealistic young people. Not one has ever told me that he wanted to go to medical school to get rich. (I tell them that if they want to achieve financial security in these uncertain times, they should consider another field.)
How do others, such as Dr. Koop, look into the students' souls? They can't do it any better than the interviewers of the last generation, who were also looking for good moral character and humanitarianism. What they \o7 can \f7 do is demean academic achievement.
Although medical school is reputedly a miserable experience, I had a wonderful time. I thought neuroanatomy and biochemistry were fascinating. I was angry at the innovators who shortened the gross anatomy curriculum to less than half a year. That wasn't nearly enough time to learn all that I thought I needed to know.
But Koop told the New Physician magazine in December that a medical student doing "respite care and helping a family through a health problem, for example, is ever so much more important than learning certain intricacies about the anatomy of the hand that you'll never use in your life." But if I'm a patient with an injured hand, I want my family doctor to know all about extensor tendons. I don't want him to miss a diagnosis. If he makes a lot of money, that's good. I want him to be committed to medicine, not pursuing a sideline business to put bread on the table.
Patients may disagree about the type of doctor they want to see. To some, willingness to abide by government regulations and take the government fees override all else. One of my patients was furious when she found out that I was no longer willing to accept money from Medicare.
"I paid my taxes," she said. "Now those doctors should have to take care of me."
When asked whether her husband, a barber, should have to give $2 haircuts to all who met government eligibility standards, she said, "that's different." (Actually, I have treated many poor people at a price they could afford--by mutual choice.)