Some of this coverage is well deserved, and many Medicare and Medicaid patients are in for a big, unwelcome surprise when they switch, or are switched, to a managed care plan. However, patients also want to pay less. Too many patients have no idea how much their care really costs, and the cost of care has in effect been proved to be too high for the growing numbers of Americans who have slipped out of the formal health care system. Increasingly, persons with full-time jobs are not offered health insurance, either because the company can't afford it or because its first loyalty is to shareholders rather than employees. For those patients who do have access, managed care is usually affordable care, and everyone from employers to employee to the unemployed wants that.
Ethics is important, but people really get heated about money.
We are living in an economic environment in which the stock market has headed north at breakneck speed for years, but the average worker's take-home pay has been stagnant. Health care is employer-based, and just like every worker's job, health care is not secure. But if physicians and patients can trust one another again, a healing, mutually accountable doctor-patient relationship is worth rebuilding, because when push comes to shove, clinicians are the ones who can help. We have one sure way to revitalize the power of medicine and to help patients who need it. We start by emphasizing accountability and service, and making our best clinical judgments, one patient at a time.