William Donaldson recognized that Aetna had trashed both patients and physicians. William Donaldson also knows that, as chairman, his first responsibility must be to the shareholders. He is obligated to look at the balance sheet and attempt to manipulate each side in order to increase the bottom line. He cannot escape his fundamental business instinct. On the expenditure side, the problem is obvious to an astute businessman.
Physicians spend too much and patients consume too much.
So the proper business response is to control this reckless spending behavior. The private health plan model that controls our system today has placed the MBA in charge. After all, cost constraints will be with us forever, and the MD would have to function within these limits. In selecting tests for the patient, the physician would be selecting beneficial tests that would be limited only by the amount of resources available. There would be no arbitrary reduction of tests to fulfill the MBA's duty to increase the bottom line.