Slaves to medicine.

In a provocative new book, 1 George Beauchamp, MD, claims that physicians are “slaves to medicine.” He explains that this is partly because “when most people go to see a doctor, both the services the doctor provides and the fees that insurance companies allow him to charge are largely predetermined by parties other than the patients and doctors.” Most patients, in turn, feel completely powerless when the time comes to submit a claim to an insurance company. They are stuck with fees that have been negotiated by a higher authority, and they are not given an opportunity to have a voice in the matter. They are slaves to a master just as people were in 350 B.C.E. (Before the Common Era), when Plato first described “free men” and “slave doctors.” I grant you that the author’s thesis hit me hard, and I thought it would interest our readers. Dr. Beauchamp claims that the central truth about health care (one that we often overlook) is a relationship based on trust. Without this special trust, the nature of the profession and its valued outcomes are inevitably perverted. He states that trust erodes when market forces, political control, and third-party interests collide. To regain the trust we have lost, physicians, nurses, pharmacists, and others must once again be placed in positions of authority, creating a morality or, in the author’s words, “a quality of care based on competence.” Finally, this trust can be sustained only when caring professionals subordinate their interests to those of patients. This is heady stuff. The heart of this new book is the idea that values—not power—should be the drivers of health care and that only two health outcomes matter: quality of life and longevity. Well, so far so good. I could certainly agree that values, not power, are critical and that quality of life and longevity make sense. Dr. Beauchamp cites a Mary & Albert Lasker Foundation study, authored by William D. Nordhaus, an economics professor at Yale. This study claimed that about 50% of the growth in the U.S. economy throughout the 20th century was attributable to improvements in health and health care. As a result of this “Nordhaus calculation,” Dr. Beauchamp believes that he has a basis for a new strategy that recognizes health care as the most powerful engine for economic growth. He extrapolates this argument and builds his thesis that “as long as we allow health care based on trust to grow and prosper, economic growth will follow.” He believes we can do away with insurance companies and all types of thirdparty payers. He supports the creation of a “federal reserve–like structure” or a “health care bank” to help sort all of this out and keep the market humming along. Ultimately, health would be the only tangible good. I believe that George Beauchamp’s work will be widely cited, because it will empower physicians and other caregivers to tackle the seemingly runaway market economy that characterizes health care today. I suppose that many of us bristle at the role of health care as a mere commodity. Finally, I am confident that other health care providers agree, as Dr. Beauchamp says, that “power and money, viewed and sought as ends, are corrupting and enslaving.” Although many of the messages in Slaves are compelling, I think the author runs the risk of losing his audience when he likens health care of the future to a “family business model” that sees all citizens as part of the health care family, where