This version of health care is purely a business

Many of us harbor an archaic view of what health care is, so let me offer a little history. During the past century, it’s changed from Healthcare 1.0 to 2.0, and now it’s Healthcare 3.0.

In the early twentieth century, Healthcare 1.0 was a service, though it amounted more to personal contact than effective medicine. At best, medications and procedures were hit-and-miss, so doctors relied heavily on their relationship with their patients. One of the era’s foremost practitioners, Dr. Edward Trudeau, advised his colleagues, “Cure sometimes, relieve often, and comfort always.”

After 1910, health care began to change as medical education became standardized and based on science. That style — call it Healthcare 2.0 — proved hugely successful. It brought us antibiotics, prosthetic and transplantable organs, the near-obliteration of polio, and many other benefits. I was trained in Healthcare 2.0.

Sometime mid-century, we began to realize that development of space-age drugs, equipment, tests, and procedures can’t be done without major capital investment, with the cost, understandably, passed on to the patient. Thus bloomed health insurance and the myriad other businesses attracted to medicine’s growing profitability. Slowly, Healthcare 2.0, health care as science, morphed into today’s Healthcare 3.0, health care as business.

Business increasingly penetrated medical practice until it totally swallowed and digested it. So now the institution is owned and directed not by physicians and patients, but by people who are familiar with commerce but clueless about what occurs in an examining room.

As a business, Healthcare 3.0 is about diagnosing and treating for payment, period. It’s not about services that don’t pay, like providing information, counseling, compassion, or comfort. Nor is it about supporting practitioners. It’s about making money.

So when your patients complain about having to wait till next Easter for an appointment; or that their medical and pharmaceutical bills are more crippling than their illness; or that you as physician spend a ridiculous amount of time either entering data or haggling for payment with insurance drones; or that you feel altogether disempowered and abused by the system: Reflect that none of this is accidental.

The institution is no longer geared to anyone’s health. It isn’t a service, Healthcare 1.0. And considering its inherent web of payola and conflicted interests, it isn’t objective science, Healthcare 2.0. It’s Healthcare 3.0, business.

To quote a line from The Sopranos, “Look, this is just business. It’s not personal.”

You can say that again.

Jeff Kane is a physician and is the author of Healing Healthcare: How Doctors and Patients Can Heal Our Sick System.

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