Medicine�s Ethical Responsibility for Health Care Reform

By John Ballard

Here is a quick read about health care reform that sheds light on the politics that have poisoned the political well. This New England Journal of Medicine article by Howard Brody opens with a big picture.

Early in 2009, members of major health care�related industries such as insurance companies, pharmaceutical manufacturers, medical device makers, and hospitals all agreed to forgo some future profits to show support for the Obama administration�s health care reform efforts. Skeptics have questioned the value of these promises, regarding at least some of them as more cosmetic than substantive. Nonetheless, these industries made a gesture and scored some public-relations points.

The medical profession�s reaction has been quite different. Although major professional organizations have endorsed various reform measures, no promises have been made in terms of cutting any future medical costs. Indeed, in some cases, physician support has been made contingent on promises that physicians� income would not be negatively affected by reform.

Said differently, the corporate suits know where the bread is buttered. Collectively they understand that health care inflation is outrunning the rest of the economy in a way that left unchecked will kill the goose laying any eggs at all. As business people they understand that their future profitability is at stake.

Physicians and other medical professionals are better medical professionals than business people. Most could not explain the difference between profit and compensation.

• Profit is a business term referring to how much money remains after taxes and operating expenses.


• Compensation is not profit. In fact compensation is one of those operating expenses.

Those last two lines are simple enough to be understood if you read them again a time or two. Profit is not the same as compensation. Before the election was finished even the medical industrial complex could see profits vanishing before their eyes. Drug companies, with the famous Medicare Part D gift from the last administration, could see that even they, like Medea, were killing their children.

I think the business giants who came to the table at the start of the health care debate knew as they walked through the door that they had to give up something to insure future profitability. I have lately heard that line "If you are not at the table, you're on the menu." Doctors as businessmen were at the table. But doctors as professionals were not. The money a doctor is paid for professional services is categorically different from corporate profits he may receive from owning a share of a corporation (hospital, clinic, group practice, marketing or medical device maker).

Read the rest of the article for your own take. It's very short and easy reading. 

Then read Maggie Mahar's comments. That's who brought the article to my attention.

If we are going to make our bloated health care system affordable, virtually everyone will have to give up something. There is no one villain in our dysfunctional system. All of us (including patients) are complicit. Just like members of a dysfunctional family, we are accustomed to things being done in a certain, counter-productive way.

That's weak tea, but it's all I have this morning. I don't expect those whose profits are impacted by change to admit the truth of what is said at these two links. All I know to do is lead the horses to water and hope for the best.