May 1981 II/9
HOW HEALTH CARE BECOMES A BUSINESS
Well over one hundred years ago, the perceptive Frenchman, Alexis de Tocqueville, wrote: "Americans have a passion for health, well-being and equality." Perhaps if he were viewing the scene in the United States today he would say,"Americans have a passion for health and well-being at the lowest possible price." The concern about the cost of health care that pervades the thinking of policymakers in the United States in our day is not in itself detrimental or ill-conceived. Utilization of human resources and material goods in a manner that benefits all members of society is of ethical concern as well as of economic concern. If the cost of health care continues to escalate it is clear that many people, usually the poor, will not be able to afford such care. Moreover, other needs of society, such as education and care for the mentally ill, will not receive enough support if more and more funds are devoted to health care. Hence, my concern is not about the effort to contain rising costs in health care. Rather, my concern is that in so doing there is danger of changing the nature of health care from a profession to a business. To put it another way, by reason of the methods employed in the effort to contain costs, health care is being changed from an humanitarian to an exclusively economic endeavor.
Consider for example, that the language people use to describe their occupations is often an accurate indicate of the way they conceive of themselves and their occupations. Consider the way the emphasis upon economic factors has changed the language of health care. Whereas we used to speak about the profession of medicine or health care, we now speak about the health care industry. Whereas we used to speak about patients, we now speak about consumers. Doctors, nurses, and hospital personnel have become providers. Health care professionals used to offer health care; they now deliver health care. Medicine, medical procedures and practices used to be evaluated in regard to their power to alleviate pain or to heal; now cost effectiveness is all important and the ultimate evaluation of medical practice is whether it enables people to become, once again, productive members of society. The list of words could be multiplied but I am sure the implication is clear. The total effect of this terminology is to make medical care a commodity; something akin to wheat, sand irons, or popcorn, and thus the "laws" of economics become the touchstone for medicine.
Not only the language utilized to describe medical care but also the subjects discussed at national meetings indicate how extensive is the takeover by economics as the "final solution." Study the programs of the annual meetings of the American Hospital Association, American Medical Association, and The College of Hospital Administrators to see how many topics concern legal or economic issues as opposed to humanitarian patient care. Finally, the emphasis on economics even leads some health care professionals to use wealth as a measuring stick for their professional and personal accomplishments; the amount of money they earn, the number of homes they possess or how many successful real estate investments they make being for some the criteria that gives them worth and meaning.
Medicine As a Profession
Looking upon the profession of medicine and health care exclusively as a business destroys its essential meaning. Medicine and health care are founded upon the realization that human beings have a set of needs which are interactive; these needs usually are enumerated as physiological, psychological, social, and spiritual. Health care professionals serve people directly in regard to two of these needs: the physiological and the psychological. But the needs of the human person are so intertwined and interactive that health care professionals also influence indirectly, and sometimes directly, the social and spiritual needs of the human person. Thus the health care professional does not work with a biological specimen or with an isolated part of the human entity. The health care professional works with an integrative sensing, feeling, thinking, loving human person.
To help a person integrate his or her needs, to help a person maintain or regain human health and well-being requires in the character of the physician such talents as wisdom, compassion, and human concern. The health care professional who is truly humanitarian says to the patient: "I shall try to heal you at every level of your being and help you become a whole person. In so doing, I shall respect your integrity as a person and treat you as an equal." The professional promises knowledge, skill and, above all, concern for the person who comes for help. In the health care profession, concern for the patient is not something "nice" or extraneous, not something added to avoid malpractice litigation. Rather, it is an integral element in the science and art of the healing professional. Moreover, the concerned and perceptive health care professional realizes that many of the really important questions (for example, is there a God? does life have meaning? will I exist after death?) surface only at the time of serious illness. The competent and compassionate health care professional is concerned that patients be able to address these questions and live with the uncertainty they generate.
Is this an idealistic view of health care? Yes, it is. But unless people have ideals that are challenging and altruistic, eventually they will lose interest in what they are doing and very often become cynical or depressed. Health care professionals are especially endangered by this syndrome of cynicism and depression because they experience and share intense human suffering, suffering which often does not seem to have any meaning. They often give time and energy to people who do not seem to have self-respect or a desire to care for themselves. Unless their ideals enable them to transcend the suffering, sorrow and squalor of the hour and day, there is danger that they will be overpowered by their experience or seek relief in frenetic activity.
If there is any truth in the concept of health care described briefly above, then one realizes immediately the implications of allowing economic factors to dominate thinking and planning in health care. qualities such as wisdom, compassion, human concern and service do not translate into economic values. If the present trend to use economic terminology and economic evaluative criteria continues, the realities these words represent as well as the words themselves will be removed from the profession of health care. Thus one of the professions which for centuries has called forth the very best in human beings will become just another fungible element in the rapacious diversion called the world of business.
Kevin O'Rourke, OP
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