Wednesday, April 22, 2009

First, do no harm v Make a buck first

First, do no harm v Make a buck first
By Ron Powell

“First, do no harm….” is the primary moral and/or ethical imperative of the medical profession. It means that the interests and needs of the patient are to be placed above the interests and needs of the physician or caregiver. Profit driven corporate medicine has taken over American medical practice. Corporate models and methods of industrial competition have eliminated clinical expertise and the notion of care in the delivery of medical services. The result is that corporate profits are more important than patient prognosis. This is not only tragic and mistaken, but also unethical and immoral.

Health care in America is no longer based on the personal relationship between doctor and patient. It is based on the impersonal relationship between corporation and consumer. The consumer of medical services is no longer perceived as the individual patient in need of medical attention. The consumers of medical services are the entities that pay for the delivery of the services: primarily the insurance companies and the government. This gives the health care provider an incentive to minimize costs by minimizing care. It makes the provider and individual patient financial adversaries.

Corporate medicine is bad medicine because it compromises patient care, is administratively inefficient, and involves unethical practices. Corporate medicine compromises patient care by disrupting the continuity of care. Nearly half of for-profit patients have been forced to change physicians. Corporate care compromises patient care by reducing staff and replacing highly trained providers with less trained providers.

Corporate care compromises patient care by subjecting the personal care plan recommended by physicians to impersonal protocols administered by untrained or less trained personnel. Corporate care compromises patient care by discouraging health care providers from advocating for quality care for their patients because managed care negotiations are time-consuming, frustrating and unpaid. Three quarters of all physicians believe managed care compromises patient care. No less than four out of five of all Americans believe profit considerations compromise quality of care.

Corporate medicine is administratively inefficient. Studies have shown that administrative costs administrative costs of for-profit hospitals are greater than not-for-profits by an average of about 25% and about 35% more than public institutions. For-profits spend more than 25% of health care premiums on administrative costs. Canada, under a national health insurance system, spends about 9% on administration, and that Medicare spends about 3% on administration. The Health Care Finance Administration has calculated that the United States would save enough money administering our health care system through a single payer to provide health care for the 44 million uninsured, while avoiding managed care and allowing free choice of providers.

Corporate medicine results in immoral, unethical, corrupt practices. True health care reform cannot and will not occur unless and until we remove profit and the profit motive from the health care equation. “First do no harm…” must come to mean that no one should reap a benefit or profit from the injury, illness, or disease that result in the misery or suffering of others.

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