President Obama's health care reform simply won't work, said Arnold Relman, M.D., former editor-in-chief of the New England Journal of Medicine and professor emeritus of medicine and social medicine at Harvard Medical School. His complaint: It doesn’t go far enough.
A reform that doesn’t address the “disastrous consequences of commercializing the health care system in the United States,” is doomed to fail, Relman told a crowded room of University of Utah medical students, providers and administrators. Relman’s solution? “Revert the system back to a social service, which is essentially not-for-profit and free of middle men who skim off so much money.” Eliminate the private insurance industry — which he “can only describe as being essentially parasitic.” Create a single-payer nonprofit system, funded by the taxpayer, which, unlike the current fee-for-service system, would offer providers “no incentive to do what doesn’t make medical sense.” Get rid of investor pressures and related waste, duplication and fraud.
“You’d save an enormous amount of money,” says Relman. And with that savings — which he conservatively calculates to be in the billions — we could offer “comprehensive care for everyone.”
The metamorphosis of an industry
To understand Relman’s radical crusade against today’s commercialized health care, it’s important to appreciate how profoundly medicine has changed since he started practicing 67 years ago. In Relman’s words, that’s “an enormous subject and obviously nothing that anyone could do in a single session would do it justice.” But there’s perhaps no one better qualified to try than Relman, who in a career that’s spanned nearly five decades has filled the top editorial role at one of the most influential medical publications in the world, taught at Harvard Medical School and acted as a health care advisor for President Bill Clinton’s administration — just to name a few accolades. Now, Relman uses that considerable experience and stature to speak bluntly about some of the most urgent and controversial questions in health care.
“When I graduated in 1946 from medical school, there was no ‘health care industry,’” Relman said. Insurance was rare. Medicare and Medicaid didn’t exist. Care was less costly and patients paid out-of-pocket. The central purpose of health care was not to make money, Relman argues, but to care for patients, adding that his 120-person graduating class “thought they were going into a profession, not a business.”
An outpouring of money post-World War II, Relman noted, radically transformed the profession. Government funding and employer-paid insurance grew. Profit-making hospitals and laboratories and other investor-owned medical businesses became common. Health care went from a “social service, professionally controlled by physicians,” Relman said, to a big business “organized and driven to chase the income that was available in the expanding industry.”
The result of that commercialization, Relman argues, is the dysfunctional health care system that we currently have. Despite spending more on health care per capita than any other country in the world, the U.S. faces skyrocketing health care costs and astonishing gaps in access and quality “The best American medical care is as good as any there is in the world,” Relman said. “But it’s the characteristic of the American, unregulated, disorganized, profit-driven health care market, that there’s also shameful areas of neglect, incompetence and dysfunction.”
Doctors charged to lead the way
Relman readily concedes the changes he advocates are sweeping, and at age 90, not something he’ll “be around to see.” But that hasn’t dampened his passion for reform.
“I conclude we’re in one hell of a mess,” Relman said, taking care to couch his doom-and-gloom assessment with the hopeful message that he’s encouraged by recent changes and believed his audience could not just see, but help create, meaningful reform.
To the doctors and medical students in the room, he issued a challenge: “Who can lead the health care reform we need? Doctors can,” he said. “So, I say to doctors: Get off your duff. Get busy. Accept responsibility. Form multi-specialty groups, and own and manage them yourselves. Accept that they’re not for-profit. And that will be the first step toward the reform we need.”
Arnold Relman, M.D., former editor-in-chief of the New England Journal of Medicine and retired Harvard professor, speaks to a crowd of medical professionals in a presentation at University of Utah Health Sciences.