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This page created April 2000 by Michael Wynne
This page examines the way in which the
market has corroded the values and ethics of the professions and
induced doctors to place care for the corporation ahead of care for
the patient.
The used car sale system works because we are conditioned to be suspicious and distrustful. The concept of human need, care, kindness and responsibility are inseparable from the idea of trust. Health care deals with people who are vulnerable and trusting. It only works when those who provide that care are motivated to meet and fulfil that expectation of trust. The outcry and anger at psychiatric hospitals in Texas in 1991/2, at aged care and managed care in the USA in 1999, and at aged care in Australia in 2000 are a measure of the public's resentment and anger when those who provide care betray this trust. In each instance it has been the market which has betrayed this trust. Doctors more than any other grouop are expected to be trustworthy. The anger and publicity when doctors betray that trust is even greater.
The role of professionalism and professional associations has been to create a context in which this trust will be met. It bars those who are not trustworthy or who have abused this trust from practising. The inclusion of probity provisions in health care regulations reflect the way in which the public and governments have in the past embraced these same professional paradigms and enshrined them in law. That professionalism may have been found wanting is no reason for replacing professionalism with a system based on distrust, a system which has repeatedly abused the trust of vulnerable people. It is much more important to see why professionalism has failed.
Walton and Moynihan have both addressed this issue in Australia. How strange that the problem they identify is the vulnerability of members of the profession to commercial pressures in the competitive marketplace - the influence of the corporate groups whose products they use. The professional paradigms which foster suspicion and distrust of commercial arrangements because of their potential impact on care have broken down. Ethical systems insist that the marketplace be kept at arms length from care. Modern Medicine has allowed those who provide care to become too close to the market.
Even a cursory examination of what has happened in the USA reveals that none of the disasters which have befallen the system could have occurred if the profession which ultimately controls what care patients receive had not bowed to the market and to the politicians who support it - if they had not signed golden handshake contracts with the big corporations and managed care - if they had not allowed the market to gain control of their professional incomes.
Dr Arnold, a psychiatrist explained in giving evidence about Tenet/NME in April 1992 that doctor's signatures were required under law before any child or adult could be admitted to a psychiatric hospital. Doctors were required to sign for all treatment. Those who signed for the care provided by the corporations became very wealthy. They were turned into respected and credible authorities. The company set up meetings where they spoke as authorities in their field. Those who objected found that they no longer had a career. They could not maintain the mortgage on their house or educate their children. If they spoke out they were attacked and their integrity questioned. It is not surprising that professionalism buckled.
Dr Arnold recorded the various conversations as Tenet/NME administrators tried, as he put it "to buy the use of his MD degree". Administrators explained how they had made others rich. Transcripts were used in evidence in Texas and copies of some of these were supplied to Justice Yeldham in 1993. A past NME administrator who also gave evidence described how successful these golden handshake agreements were in trapping doctors into a web from which they could not escape.
When I talk about need, health care and health care expense I am not talking about the medical periphery, costly nose jobs or tummy tucks for film stars and models. Nor am I talking about massages for aching muscles after exercise or sitting at a computer. I am not talking primarily about the minor ailments and problems which are the everyday experience of health care for most of us. I am talking about serious illnesses, about vulnerable and gullible people, children, the illnesses of aging, heart disease, cancer, dementia and psychiatric diseases, and about caring for loved ones who have made their contributions to society - people to whom we owe a debt of trust.
These are where costs are highest, where most profit can be made, where people are most vulnerable and where the market is most inappropriate. Most only occur once or twice in each lifetime and then later rather than sooner. When they do it is catastrophic, and too late for them to revise their early experience of health care and act. These are the needs of our citizens as contrasted with the demands for nose jobs and a good squeeze. This is where professionalism is so important.
Most of us have made minor claims on insurance policies and have been very satisfied with the response. Only a small number of us have made really large claims. The experience is a very different one - so it is with health care.
CLICK HERE -- for another page which addresses the failure of professionalism.