Welcome to Medicine, Inc.: Professionalism V. Production

Abstract

The failed Health Security Act of 1993 was the final federal venture into universal health insurance of the twentieth century. Despite its proposed use of private markets and financial incentives to implement insurance, its broad scope prompted its detractors to label the act as a government takeover of health care. In its absence different types of managed care organizations grew increasingly commonplace during the 1990s. Early very restrictive versions of health maintenance organizations were unacceptable to physicians and patients alike. Although doctors’ concerns were disregarded, the dissatisfaction of employees and their employers drove the insurance industry to adopt relatively more lenient plans. Physicians reluctantly agreed to participate in exchange for patient retention as well as the perception of somewhat improved professional autonomy. In reality, however, private practices over time became progressively more dependent upon deeper pockets for financial support. During the past several decades hospitals have gained economic power through mergers and acquisitions. Furthermore some physicians who have prospered in this environment have given first priority to business interests, and are positioned to influence the professional autonomy of other physicians in their employ. Those who favor high quality of care at the expense of productivity place themselves in professional peril.