Believing that the corporate invasion of medical care has become a disaster for American medicine, a group of physicians in Boston has formed The Ad Hoc Committee to Defend Health Care. The committee seeks to focus the attention of the public on “the deterioration of care and caring, and to initiate a colloquy on a future for health care guided by compassion, rather than greed.”
The committee's statement, expressed as a call to action, has already been endorsed by more than 2,000 physicians and hundreds of nurses. It is scheduled to appear in the Journal of the American Medical Association (JAMA) on December 3, 1997. Its publication is to be coordinated with letters to the editor, newspaper advertisements, and a symposium at historic Faneuil Hall. The committee hoped to link this symposium by satellite to gatherings at other sites around the country.
The organizers mounted a national telephone conference on July 10, 1997. More than 270 participants shared their views on the declining quality of health care as a result of consequence of for-profit corporations' taking over American medicine. Some of the effects discussed were the deprofessionalization of doctors and nurses; the depersonalization of patients; the denial of high quality care to patients; the rise in the number of uninsured patients; patients' lack of awareness of the gravity of the situation; and physicians' fear, intimidation, and demoralization in the face of managed care corporations' tactics, leading to a tendency to capitulate to managed care.
As no psychoanalysts or psychiatrists had yet identified themselves during the telephone conference, Ad Hoc Committee members spoke up and commented on the destructive effects of “carveouts” and managed care restrictions on psychotherapy and psychoanalysis. They spoke of how fear of stigmatization keeps psychoanalytic patients from speaking out and insisting on adequate coverage for quality care. The committee was gratified the next day to hear by phone from Joel Rosen, an active member of The American from Stockbridge, Mass., who had also been listening in on the teleconference. He echoed the organizers' distress at the destructive effects of for-profit health care, psychoanalysts' sense of isolation, and the need to reach out and join with other colleagues to remedy the situation.
What follows are excerpts from the committee's Call to Action.
“We are physicians and nurses from across the spectrum of our professions. We serve patients rich and poor; in hospitals and clinics, private offices, and HMOs; in public agencies, community settings, and academia. Mounting shadows darken our calling and threaten to transform healing from a covenant into a business contract. Canons of commerce are displacing dictates of healing, trampling our professions' most sacred values. Market medicine treats patients as profit centers. The time we are allowed to spend with the sick shrinks under the pressure to increase throughput, as though we were dealing with industrial commodities rather than afflicted human beings in need of compassion and caring. The right to choose and change one's physician, the foundation of patient autonomy and a central tenet of American medicine, is rapidly eroding.
“Doctors and nurses are being prodded by threats and bribes to abdicate allegiance to patients, and to shun the sickest, who may be unprofitable. Some of us risk being fired or ‘delisted’ for giving or even discussing expensive services, and many are offered bonuses for minimizing care. Listening, learning, and caring give way to deal-making, managing, and marketing. The primacy of the patient yields to a perverse accountability — to investors, to bureaucrats, to insurers, and to employers. Patients worry that their doctors' judgment and advice are guided by the corporate bottom line.
“Public resources of enormous worth — non-profit hospitals, visiting nurse agencies, even hospices — built over decades by taxes, charity, and devoted volunteers, are being taken over by companies responsive to Wall Street and indifferent to Main Street. Communities find vital services closed by remote executives; savings are committed not to more pressing health needs, but to shareholders' profits. Not-for-profit institutions, forced to compete, must also curtail unprofitable activities like research, teaching, and charity, or face bankruptcy. Hospital chains' profits reach $100 per patient per day; a single HMO president nets $990 million in a takeover deal; and insurers' overhead consumes $46 billion annually.
“At the same time, the ranks of the uninsured continue to grow while safety net hospitals and clinics shrink and public health programs erode. Even many with coverage insurance find coverage deficient when they need it most; care or payment are too often denied for emergencies or expensive illnesses. The sick are denied skilled nursing care, rushed out of hospital beds, and hurried through office visits. Increasingly, patient comfort and the special needs of the elderly, infirm, or disabled are ignored if they conflict with the calculus of profit.
“The shift to profit-driven care is at a gallop. For nurses and doctors, the space for good work in a bad system rapidly narrows. For the public, who are mostly healthy and use little care, awareness of the degradation of medicine builds slowly; it is mainly those who are expensively ill who encounter the dark side of market-driven health care.
“We criticize market medicine not to obscure or excuse the failings of the past, but to warn that the changes afoot push nursing and medicine further from caring, fairness, and efficiency. We differ on many aspects of reform, but on the following, we find common ground:
“1. Medicine and nursing must not be diverted from their primary tasks — the relief of suffering, the prevention and treatment of illness, and the promotion of health. The efficient deployment of resources is critical but must not detract from these goals.
“2. Pursuit of corporate profit and personal fortune have no place in caregiving.
“3. Potent financial incentives that reward overcare or undercare weaken doctor-patient and nurse-patient bonds and should be prohibited. Similarly, business arrangements that allow corporations and employers to control the care of patients should be proscribed.
“4. A patient's right to a physician of choice must not be curtailed.
“5. Access to health care must be the right of all.
“Before the values we cherish are irretrievably lost, we invite members of the health professions and the public to join in a dialogue on health care's future. The headlong rush to profit-driven health care has occurred without the assent of patients or practitioners, through a process largely hidden from public scrutiny and above citizen participation. This must be replaced by an open and inclusive process that is not dominated by the loudest voices — those amplified by money and political influence.
“America's history is replete with examples of powerful social movements kindled by initially unimposing moral voices: in the 18th century the Boston Tea Party, in the 19th,
abolitionism; and in the 20th century, appeals for civil rights and nuclear disarmament. Only a comparable public outcry can reclaim medicine. We believe that our professions' voices can gain extraordinary resonance when we speak selflessly in patients' interests. We pledge the following initial steps:
“1. We will petition our governors, legislatures, and attorneys general for a moratorium on for-profit takeovers of hospitals, insurance plans, HMOs, physicians' practices, and other health care institutions. We expect public officials to oppose such takeovers and not to abrogate their duty to safeguard indispensable community resources. We urge colleagues in every state to join in the call for a moratorium, pending the development of comprehensive state and national policies addressing these issues.
“2. On the publication date of this Call, physicians and nurses will convene in the historic heart of Boston. This open meeting will call the public's attention to the deterioration of care and caring, and initiate a colloquy on a future for health care guided by science and compassion rather than greed. We invite colleagues across the nation to gather simultaneously at similar meetings, linked by satellite.
“3. These events will launch an ongoing series of teach-ins and meetings to discuss the health care crisis. We ask that each health institution across the nation devote a major conference such as Grand Rounds to the moral crisis facing our professions.
“Our goal is not endorsement of a prespecified program for medical reform. Indeed, we believe that a number of programmatic solutions could provide the humane, comprehensive, and equitable care that our nation deserves. We seek an inclusive and empowering dialogue with patients and the public to formulate a caring vision true to the community roots and Samaritan traditions of American medicine and nursing.”
If you are interested in participating in this enterprise, contact The Ad Hoc Committee To Defend Health Care, 21 Longwood Ave., Brookline, MA 02146, or phone 617-576-7741.