While the essay nails it in the title, that it is the health system demoralizing physicians, the writer falls well short of correctly analyzing the root cause and subsequently offering a plausible solution. The system has fallen under the control of profiteering middle-men operating under an economy that is rife with perverse incentives maintaining a steep cost curve. No amount of organizing is going to effectively reverse this trend. What we need are physician leaders working with industry to re-create a system that re-establishes the patient-physician relationship and arms length financial transactions for health care delivery. Mark Cuban gets it. What he is doing for generic drug purchasing can be done on a larger scale for primary and specialty medicine. The capital costs for such an endeavor will be so large that it can only be done in conjunction with one or more of the giants of industry. Some, like Amazon and CVS, are jumping in, but in my humble opinion are going about it from the wrong angle, first of all trying to muscle their way in to a failing third-party payer system that will maintain the status quo at any cost, and second of all trying to do it at national scale from the get go. It needs to start out locally, as healthcare delivery should be a local economy, and proof of concept needs to occur on a local scale. Start out, for instance, in states with no CON laws. Bucky Fuller said it best: "You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete." Let the “healthcare universalists” have at it! I want to create something better, separate but in parallel to their current mess, that will make them obsolete. My final point is my most important: health care at its very core is first a moral enterprise. Let’s keep it that way. There must be at least one industry giant out there who can agree with that!
Sorry for the rambling... too much to say in a short comment. Thanks for reading through, and thank you Bryan for your thoughtful and sensible writing.
I don't think the suggestion was that participating in picket lines and other activities associated with unionizing/organizing were cathartic and would make us feel better and less demoralized. The suggestion was that physicians don't feel like they have as much of a say in the structure of healthcare and maybe we'll feel less demoralized if we had a say. I am also skeptical of the piece, but I think you're critiquing a poor representation of the essay's argument.
While the essay nails it in the title, that it is the health system demoralizing physicians, the writer falls well short of correctly analyzing the root cause and subsequently offering a plausible solution. The system has fallen under the control of profiteering middle-men operating under an economy that is rife with perverse incentives maintaining a steep cost curve. No amount of organizing is going to effectively reverse this trend. What we need are physician leaders working with industry to re-create a system that re-establishes the patient-physician relationship and arms length financial transactions for health care delivery. Mark Cuban gets it. What he is doing for generic drug purchasing can be done on a larger scale for primary and specialty medicine. The capital costs for such an endeavor will be so large that it can only be done in conjunction with one or more of the giants of industry. Some, like Amazon and CVS, are jumping in, but in my humble opinion are going about it from the wrong angle, first of all trying to muscle their way in to a failing third-party payer system that will maintain the status quo at any cost, and second of all trying to do it at national scale from the get go. It needs to start out locally, as healthcare delivery should be a local economy, and proof of concept needs to occur on a local scale. Start out, for instance, in states with no CON laws. Bucky Fuller said it best: "You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete." Let the “healthcare universalists” have at it! I want to create something better, separate but in parallel to their current mess, that will make them obsolete. My final point is my most important: health care at its very core is first a moral enterprise. Let’s keep it that way. There must be at least one industry giant out there who can agree with that!
Sorry for the rambling... too much to say in a short comment. Thanks for reading through, and thank you Bryan for your thoughtful and sensible writing.
I don't think the suggestion was that participating in picket lines and other activities associated with unionizing/organizing were cathartic and would make us feel better and less demoralized. The suggestion was that physicians don't feel like they have as much of a say in the structure of healthcare and maybe we'll feel less demoralized if we had a say. I am also skeptical of the piece, but I think you're critiquing a poor representation of the essay's argument.