We do not have a health care system

I do not provide health care. What we physicians do is practice medicine, and what we do for patients is called medical care.

No one says, “I want some health care.” What they think is, “I don’t feel well. I want to see a doctor.”

People get sick and they get hurt. It’s true that many these conditions occur as a result of things they do (smoke, eat junk food, drink too much alcohol, go skiing) or don’t do (use seat belts in the car or helmets when riding motorcycles, exercise regularly). But even if everyone in the whole country made perfect choices all the time, they would still need medical care for illnesses and accidents from time to time.

One of the wonderful things we can do these days is keep people from getting sick. This is called preventive medicine. We have primary prevention, such as vaccines to prevent certain infectious diseases, and secondary prevention, such as taking aspirin and statins after a heart attack to prevent you from having another one.

We can also find some diseases before the patient has any symptoms of it. Sometimes (not always!) we can treat it then, preventing symptoms in the future and possibly (possibly!) prolonging life.  This is called screening. It is still a form of medical care.

Health care is a made up term. It was invented by administrators, bureaucrats, and politicians (people who do not provide medical care) to insinuate themselves into the process between people who are either sick or hurt, or who feel well and wish to avoid becoming sick or hurt, if possible, and the people whose care they seek. Their sole purpose is to siphon off as much of that revenue stream as they possibly can, leaving an ever shrinking pool of funds to pay the doctors and hospitals (meaning nurses, technicians, and housekeepers) who actually take care of people who are sick or hurt.

Sadly, they’ve done an awesome job of it. One of their strategies is recruiting doctors who are tired of fighting them to come join them … not coincidentally by greatly enriching them in the process. But every doctor seduced away from taking care of patients (our word for “people who are sick or hurt”) means one fewer available to make a real difference in the lives of real people.

What would I do to reform the “health care” system? Begin by abandoning the words health care and going back to calling is what it is: medicine.

Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.

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  • SteveCaley

    Thank you so very much, Dr. Hornstein. If what we do is good for people, shouldn’t the support systems act to make our work more efficient – to support the delivery of care? Imagine if NASA treated its astronauts this way – they’d never survive a mission! I’ll bet they would have to pay for their meals and lodgings in space, as well. :-)

  • lord acton

    Dr. Hornstein, what you are asking is easily done, at least for those of us who provide primary care. I stopped taking insurance 4 years ago and work for my patients. Neither they nor I have missed the middle men. Thanks for a nice post.

  • eqvet2015

    It also is far too chaotic and fragmented to be called a system. How about “melee”?

  • DinoDocLucy

    I agree in principle. The problem is something called economic micro-environments. Not everyone is willing to pay their doctors (especially if they also have to pay insurance premiums). Somehow the visceral feeling in this country is often that medical care should be free; not everyone feels this way, but many do. Sadly, for every no insurance-direct pay success story, there are several failures we never hear about.

  • DinoDocLucy

    Exactly so. This point was hijacked by the title, which was not the same as the one on my blig.

  • Alene Nitzky


  • SonoIo

    thoughtful post. The language we use has had a huge impact on how medicine has changed. We are “providers” and patients are “customers” and that’s just not right. If you are at an Urgent Care center, perhaps. On the other hand, as a doctor, I know, i’ve had some piss poor doctors – and I get how patients can be angry – I can see how they want to get some control back. But you can’t take a highly trained, caring professional and treat him as a de facto criminal and ask him to provide perfect, loving care. It’s bizarre.

  • wiseword

    Thank God — and you — for your posting. I have been screaming for years “Medical! Medical! Not health!” Health care is everything you do from the minute you wake up until you go to sleep. Medical is when your appendix bursts, you break your leg, or you have a dread disease. Health is do-it-yourself. Medical needs experts.

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