When we buy something we look it over and make a simple decision; is it worth what I will pay for it if I decide to buy it? The relationship is a direct one between the buyer or supplier and the consumer. In the case of medical care this relationship was also simple prior to the establishment of the HMO’s, Medicare and “third party payers”. At the present time, since the consumer is no longer the one who pays the bill, the situation has changed. In the days when patients were treated by a physician, it was the patient who needed to be satisfied. The patient usually measured the care he received by the amount of attention he was given, the palliation of his or her symptoms and the empathy of the physician (this of course was before he was turned into a caregiver}. The relationship was simple and the only one that had to be satisfied was the patient. In our present environment this relationship has been altered considerably. To begin with, not all patients can choose which physician they will see as their health plan or insurance will guide many patients. If the physician satisfies the patient this is all great, however, it is not the patient who determines whether the treatment he or she received is satisfactory. In most instances the insurance company, Medicare or HMO that pays the bill is the entity that must be satisfied. These entities have no pain or suffering that can be used as a gauge nor are they present in the examining or treatment room. For these entities satisfaction and evaluation are based on the record generated and the justification for the charges that have been submitted. The result can easily be seen. The physician’s charges are best justified by paperwork. The resulting therapeutic result is that the patient gets slight attention but the record is bolstered by all means possible. Office visits must be kept short so that more patients can be seen. The older physician whose clientele is primarily Medicare is pushed quite hard to see enough patients so that he or she can justify keeping their office open.
The recruit in the military who is given a military haircut gets a foretaste of what to expect from “Governmental Medicine”. The relationship between the one who shears recruits and the recipient of this treatment provides a foretaste of what medical care can become. The recipient and the one who pays are not related and their goals are not always identical.