Do Physicians Have a Responsibility to Meet the Health Care Needs of Society?

An interesting article appears in the Fall 2012 issue of the The Journal of Law, Medicine & Ethics by Allan S. Brett titled “Physicians Have a Responsibility to Meet the Health Care Needs of Society.” Allan opens the article by addressing a question that was posed to Ron Paul in the 2012 presidential election by Wolf Blizter which I mentioned before on this post

Allan aruged that Ron Paul agreed with the sentiment that “physicians have a responsibility to meet the health care needs of society.”

In the article Allan makes the following case.

“In the rest of this essay, I first demonstrate that society is already organized— at least in part — to rescue sick people regardless of ability to pay, and that society is not prepared to abandon that general guiding principle. It follows that physicians — society’s principal instrument for provision of health care services — are expected to meet society’s health care needs. I then argue that the current configuration of the U.S. health care system undermines the ability of physicians to fulfill this mandate effectively. And finally, I argue that the medical profession’s responsibility to meet society’s health care needs also carries a responsibility to practice cost-effectively.”

Later in the article Allan states

“The system of health care delivery in the United States is a patchwork consisting — among other things — of reasonably universal access for urgent medical care, barriers to non-urgent but necessary care for uninsured or under-insured people, and government sponsored coverage for some (but not other) populations. As a result, the system is clinically illogical and operationally dysfunctional. We try to have it both ways: as a matter of human decency we provide urgent medical care without regard to cost, but along the way we demand individual patient responsibility for costs. We boast about offering the best medical care in the world, yet we knowingly provide substandard care (or deny care) to large numbers of people, and we experience health outcomes inferior to those of comparably developed nations.”

Allan expands on some of these points by discussing how medical debt causes bankruptcies and how charitable groups hold picnics or other fund raising events to raise money for medical care. Further Allan mentions how some doctors and hospitals are expected to write off some medical bills for charitable purposes but this results in cost shifting and causing paying patients to pay higher premiums. Allan later mentions how

“A majority of medical schools in the United States are state institutions that receive taxpayer support. Many medical students receive government-sponsored grants and low-interest loans.”

Later in the article Allan says

“Indeed, public opinion opinion polls have shown consistently that a majority of Americans favor some system of guaranteed universal access. Politicians and analysts who claim that “American individualism” or “American exceptionalism” are antithetical to universal access are simply misrepresenting the values of the majority (while representing narrow interests with economic or political motives to maintain the status quo).

Allan goes on to say

“The point here is to emphasize that a system of guaranteed universal access — in which physicians are compensated fairly for provision of medical care to the rich and poor alike — allows physicians to satisfy professional obligations to meet society’s health care needs, and to meet ethical obligations to treat patients without discrimination.”

Allan later says

“…many physicians have placed their own financial interests above the interests of patients by providing unnecessary medical care that is highly profitable under fee-for-service arrangements. There is strong evidence that provision of useless medical care accounts for a substantial proportion of health care costs — up to 30% by some estimates. Physicians tend to blame the steep rise in health care costs on patients (“patients demand things, and I don’t have time to fight with them”), on lawyers (“I do more things than necessary so I won’t get sued”), and on drug company influence on physician prescribing. Then, having driven up costs, physicians blame payers for interfering with medical practice. Although demanding patients, lawyers, and drug company advertising are an inescapable part of the health care landscape, their existence does not excuse physicians from practicing evidence-based, cost-effective medicine.”

The article by Allan S. Brett is well written and he makes his point effectively about why the medical profession has a responsibility to meet society’s health needs. I encourage you to read the entire article.

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