Dean Kagan was not my Harvard Law School professor of constitutional law, but Professor Arthur Sutherland, a gentle scholar with a penetrating mind (and wit) was. He taught us that rights are closely tied to obligations. Although health care issues may seem too mundane to be linked to Harvard legal principles, Sutherland's message remains relevant: health care rights and obligations are inextricably linked.
In 2008, when I started this blog, I discussed the franchise that health care professionals obtain when they receive their licenses, granting them their rights to practice, and noted that their rights were accompanied by serious professional obligations to provide services in the public interest which those licenses were granted to serve. For physicians, it means the obligation to provide care for desperately ill patients who may not be able to afford the health care provider's "usual and customary fee." For licensed (franchised) hospitals, whether for-profit or not-for-profit, it means taking care of the needs of those who would become seriously impaired, suffer unnecessary pain, or die without the hospital services the institution is licensed to provide. For licensed (franchised) insurance companies, it means considering issues above and beyond profit when underwriting and providing insurance benefits. For patients who proclaim their rights to health care, it means taking those personal measures which promote health rather than (i.e., alcohol, tobacco and dangerous drugs as well-as high-risk behaviors) demand that society take the responsibility to correct the damage they have done to themselves. It may mean understanding that the demands which an individual makes on the health care system may be unrealistic, unnecessary and economically impossible and, if met, may result in the system being unable to provide basic care to others.
Each of us will require health care. When we (or our surrogates) make demands upon the our health system, we should understand the system's capacity, it's obligations and our own. Health care does not represent a bottomless trough at which we can all line up to get our fill. Nor is it an ever-growing source of revenue to its franchisees.
What are your health care rights? And what are your obligations?
Showing posts with label License. Show all posts
Showing posts with label License. Show all posts
Thursday, July 1, 2010
Tuesday, January 26, 2010
Suck It Up: Medical License = Government Franchise + Obligations
A license to practice medicine, or function as a health care professional in any of the allied fields which require government certification, is a franchise. It gives the holder the unique ability - in the furtherance of public interest - to provide personal and technical health services in exchange for payment - to people within its jurisdiction. Non-licensed persons cannot hold themselves out as able to provide and charge for those services. A franchise protects its holder from competetition.
The report that a nationally recognized medical organization has refused to provide further or future care to Medicare beneficiaries is disturbing. It is inconsistent with the essential caring spirit of physicians, nurses and other health care professionals and institutions and and contrary to the public service requirement that the franchise invokes. Systematic exclusion from receipt of services because one is a Medicare beneficiary is un-American and wrong.
The United States needs a reformed national health care system, not parochial local or state operations. The essential requirement for critical health care services, such as obstetrics, cancer treatment, fracture care, treatment of devastating infections and the skills, equipment and facilities necessary to deliver these services doesn't change from rural Georgia to Arizona or Ohio. State licensure of health care personnel is an anachronism: if a physician has the requisite evidence of competence and personal conduct qualifications to provide care in New York, why should that person be forbidden to practice medicine in Utah without going through an entirely new, expensive, time consuming and resource wasting evaluation. If a physician in Florida has practiced competently for fifteen years and moves to Minnesota, why impede that change by measures which are formulated specifically to reduce competition in the guise of "licensure quality"? Why not have federal licensing in full recognition that the federal government is the major funder of health care services and facilities? Why not have federal standards which will protect every patient and every provider in the United States rather than the wasteful duplication of political-administrative functions in every jurisdiction in our nation?
Physicians and other providers know that dealing with health care insurers is more disruptive to their practices, in terms of inadequate compensation, bureaucratic bottlenecks and denial of essential services to patients, than dealing with the federal government. The federal government, hamstrung by political contributions and lobbying, has not engaged with insurers to set matters right except for patients covered by Medicare. There is no fair uniform protection of patients and health care providers from financial ruin in the event of medical malpractice or the determination that malpractice has occurred (the public is not aware of the extraordinary cost of medical malpractice insurance to many practitioners, including those who have never lost a malpractice lawsuit). Our government has failed to deal with inflation in pharmaceutical costs and its impact on health care providers, patients and their families. The federal government has cost-shifted its drug war by imposing $500 fees on providers for a 3-year Drug Enforcement Administration license, using health care providers as cash-cows rather than as a vital part of our system of health care.
The government grants a franchise. Providers have to provide necessary health services to all of the public that the franchise envisions. And government has to reasonably protect health care providers, and all Americans, from being financially gouged by parasitic uncontrolled interests including those masquerading as government agencies or licensees or contractors. If not, as is the case today, we all lose.
The report that a nationally recognized medical organization has refused to provide further or future care to Medicare beneficiaries is disturbing. It is inconsistent with the essential caring spirit of physicians, nurses and other health care professionals and institutions and and contrary to the public service requirement that the franchise invokes. Systematic exclusion from receipt of services because one is a Medicare beneficiary is un-American and wrong.
The United States needs a reformed national health care system, not parochial local or state operations. The essential requirement for critical health care services, such as obstetrics, cancer treatment, fracture care, treatment of devastating infections and the skills, equipment and facilities necessary to deliver these services doesn't change from rural Georgia to Arizona or Ohio. State licensure of health care personnel is an anachronism: if a physician has the requisite evidence of competence and personal conduct qualifications to provide care in New York, why should that person be forbidden to practice medicine in Utah without going through an entirely new, expensive, time consuming and resource wasting evaluation. If a physician in Florida has practiced competently for fifteen years and moves to Minnesota, why impede that change by measures which are formulated specifically to reduce competition in the guise of "licensure quality"? Why not have federal licensing in full recognition that the federal government is the major funder of health care services and facilities? Why not have federal standards which will protect every patient and every provider in the United States rather than the wasteful duplication of political-administrative functions in every jurisdiction in our nation?
Physicians and other providers know that dealing with health care insurers is more disruptive to their practices, in terms of inadequate compensation, bureaucratic bottlenecks and denial of essential services to patients, than dealing with the federal government. The federal government, hamstrung by political contributions and lobbying, has not engaged with insurers to set matters right except for patients covered by Medicare. There is no fair uniform protection of patients and health care providers from financial ruin in the event of medical malpractice or the determination that malpractice has occurred (the public is not aware of the extraordinary cost of medical malpractice insurance to many practitioners, including those who have never lost a malpractice lawsuit). Our government has failed to deal with inflation in pharmaceutical costs and its impact on health care providers, patients and their families. The federal government has cost-shifted its drug war by imposing $500 fees on providers for a 3-year Drug Enforcement Administration license, using health care providers as cash-cows rather than as a vital part of our system of health care.
The government grants a franchise. Providers have to provide necessary health services to all of the public that the franchise envisions. And government has to reasonably protect health care providers, and all Americans, from being financially gouged by parasitic uncontrolled interests including those masquerading as government agencies or licensees or contractors. If not, as is the case today, we all lose.
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