Healthcare for All
Would you be able to trust your Doctors to always make the best decisions regarding your healthcare needs if the Doctors gain money by providing less care or lose money by providing too much care? This is the essence of Medicare’s Shared Savings Program—Accountable Care Organizations (ACOs). In other words: “encouraging insurers and providers to put their own financial interests’ above the medical needs of patients.”1 The Doctor is becoming both the deliverer and denier of healthcare. “These policies are designed to increase savings for the (Medicare) Trust Fund…”2
ACOs have been steadily growing since 2012, and now cover over ten million Medicare patients. They have spread across the nation, and are also being implemented by Private/Commercial health plans as a means to increase their profits. Over 23 million patients nationwide are part of the ACOs and the numbers are steadily growing.
American medicine is abandoning ancient oaths and trust. For thousands of years physicians took oaths to always act in their patients’ best interest. The World Medical Association in 2006 specified: “A physician shall not allow his/her judgment to be influenced by personal profit.”3 The profit motive has corrupted the relationship between patient and doctor. This long-standing trust is being shattered by the ACOs medical delivery system. The need for profits is driving these changes. The rich one percent demand higher profits from Congress and have received tax cuts for their corporations and banks. Tax cuts mean the Government has less money to spend on social programs. The squeeze on profits due to worldwide competition and economic stagnation builds pressure to cut social programs and use the funds to pay back bankers, fund the military/war machine and subsidize corporations. ACOs are tools to help achieve this goal by pitting doctor and patient against each other as they fight over decreasing funds for healthcare. Yes we need universal healthcare for all, but the profit system must be eliminated. A public health system driven by patients needs, can preserve trust between patient and healthcare workers and best serve the health needs of the population.
Most of today’s major diseases have large social determinants. Social determinants of health are an underlying cause of today’s major societal health dilemmas including obesity, heart disease, diabetes, and depression.4 The World Health Organization (WHO) offers this definition of social determinants of health: “The conditions in which people are born, grow, live, work and age.”
Doctors and hospitals have little potential to affect social determinants of disease, but a movement for an egalitarian society of social, economic and political equality, does have the potential to change these conditions. Eliminating racism, poverty, unemployment, inequality, hunger, etc., will do the most to improve people’s health and is a goal that patients and health care workers can find worth fighting for.
Dr. Gordon is a California Family Physician.
1 https://www.forbes.com/sites/sallypipes/2014/09/22/the-bungling-of-bundled-payments/#49defd9c1c60
3 https://countercurrents.org/2018/01/exsanguination-medical-ethics