Health care reform per Robin Cook

I practiced pediatrics in several settings including government, HMO and private practice for over 20 years. In my semi-retirement forced on me primarily by my personal medical situation, and as an extreme liberal, I found this short (relatively) diatribe on the current state of the US health care nonsystem to be, quite frankly, RIGHT ON!

In his most recent novel, Cure, the prolific medical thriller writer, Robin Cook, had this to say about a doctor who got into legal trouble because of his greed:

"The fatal flaw of greed evidencing itself in an individual who most likely started out with an altruistic desire to help people, just like ninety-nine percent of other medical students."

"It's the unfortunate marriage of medicine and business. In the mid-twentieth century you could do well in medicine, but you really couldn't become truly wealthy. All that changed when medicine in this country did not emerge as a responsibility of government, like education or defense, as it did in most every other industrialized country. Add to that the US government inadvertantly contributing to medical inflation by passing Medicare without effective cost controls, by generously subsidizing biomedical research without maintaining ownership of the resulting discoveries for the American public. and by its patent office awarding medical process patents life for human gene sequences, which it is not supposed to do by law. I tell you, the medical patent situation in this country is a total mess, which is already starting to haunt the biomedical industry, but that is another issue."

"Unfortunately today if a doctor wants to become truly wealthy, and a lot of them do, it is reasonably within their grasp by choosing the right specialty, getting involved in the pharmaceutical industry, the health-insurance industry, the specialty-hospital industry, or the biotech industry. All these industries say they exist to help people, which they can, but it is more of a byproduct, not the goal. The goal is to make money, and do they ever."

".....most if not all medical students are altruistic to begin with , but they are also competitive. They have to be, to get into the best college, to get into medical school, and to do the best to get the most coveted residencies to get into the best medical specialty, meaning, most likely, the one that pays the most so they can pay down their student loans the fastest. What they don't realize is that the profession in this country has drastically changed over the years, mostly because of economics."

Note: when the discussant was asked if health care reform legislation could fix this problem, the good doctor replied:

"In a generous moment, I might say it is a start At its core there is the goal of some sense of social equality in regard to medical care as a resource and a responsibility of government. But in this country medical care is a competitive stakeholder industry, and the new legislation does not change that; it just resorts the relative power of the stakeholders. I'm afraid the ultimate effect is going to be more pressure for costs to rise, since, like Medicare, there are not enough spcific cost controls."

None of this is new, much of it reflects the views of many medical economists (Ewe Reinhardt and Paul Krugman) and curmudgeonly docs like Arnold Relman, Marcia Angell, and John Abramson (to name but a few). But it is an interesting way for a fiction writer like 'Robin Cook (himself a trained MD) to work in some economic/political analysis into a story.