From Richard N. Fogoros, M.D.,
Your Guide to Heart Disease.
FREE Newsletter. Sign Up Now!

About.com Health's Disease and Condition content is reviewed by our Medical Review Board

By DrRich

Most observers agree that the American health care system is broken. The major point of disagreement is on why it is broken. Depending on where you're sitting, the problems we're experiencing are caused by the heartless HMO's, the overzealous regulators, the greedy doctors, or the overly demanding patients. But, while there's some truth to all these explanations, none of them really hits the mark. This lack of understanding as to what's wrong with our health care system is anything but benign. Until we grasp the true causes of our growing health care crisis, we are doomed to repeat the same mistakes; the crisis will continue to worsen, and eventually we'll all pay the price, deeply and personally.

Today in the American health care system you're more alone and more at risk than you probably realize. This is a system growing more dysfunctional - and more hostile - by the day. You need to learn how to protect both yourself and any loved ones who may need health care. But in order to survive this health care system, first you must understand it.

Covert rationing and the doctor-patient relationship

DrRich deals with this issue in depth elsewhere. For now, let's just get to the bottom line: The fundamental issue with American health care is the rationing problem. This is not a problem of whether to ration - we don't have any choice about that, since we simply can't buy all the health care that might be useful for every individual - but how to do it. And since rationing health care is politically unfeasible (despite the fact that we don't have any choice about it), there is only one answer to the "how" problem: we've got to ration covertly.

Covert rationing means rationing (that is, withholding care) without mentioning it to anybody. And the only way to accomplish that is to have the doctors do it, quietly and whenever possible, subconsciously, at the bedside. Covert rationing requires that doctors, when making decisions about what tests to order and what care to give, must take into account something other than what's best for the individual patient sitting before them. That "something other" might be any of a multitude of factors, such as the regulations promulgated by the feds, personal financial incentives promulgated by health plans, interpreting scientific data with a certain slanted viewpoint, or peer pressure to behave in a certain way for the good of the profession or the specialty or the practice (i.e., protecting turf.) The point being that covert rationing - which, like it or not our society has fully embraced - requires, as a fundamental tenet, the systematic destruction of the doctor-patient relationship.

The importance of the doctor-patient relationship

DrRich will illustrate by analogy why the doctor patient relationship is so important: Let’s say that one-day, down on your luck and in need of some quick cash, you decide to rob a Seven-Eleven. You rush in brandishing a .38, and order the clerk to hand over all the cash. He turns out to be a wise guy, so you shoot him. You quickly clean out the register and head for the door – where you run smack into two burly police officers who happen to be entering the store right then for some of that good Seven-Eleven coffee. You are quickly and none-too-gently disarmed and arrested. So there you are – caught red-handed, money in one hand, gun in the other, the blood of the clerk on your shirt, and the whole thing recorded, in living color, by a hidden video camera.

Now, here’s the question: What rights are you entitled to?

Despite the fact that anybody can see how guilty you are, you have many rights. You have the right to a fair trial. You have the right to be considered innocent until a jury of your peers declares you guilty. And you have the right to appeal the verdict (assuming, of course, that you won’t like it). But most importantly and above all else, you have the right to counsel, an advocate, an individual who is obligated to defend you against all odds, to the best of his or her abilities, and to protect your interests against the world.

Page 2 - What does the loss of the doctor-patient relationship mean to you?

This article adapted with permission from YourDoctorintheFamily.com