BETWEEN 1990 and 1995, for-profit HMOs grew 15-fold in market value and overall membership. This rapid growth is particularly startling considering that for-profit corporations are obligated to maximize the return on the shareholder's investment, creating an inherent conflict between quality of care and profit.
This concerns a group of us, first-year medical students at Johns Hopkins. We fear that medicine is headed in the wrong direction: that by the time we take the Hippocratic oath, physicians will no longer be allowed to put the interests and that of their patients above financial considerations.
We discovered that we are not alone in fearing for the future of medicine in the United States. We rallied around an initiative born in Massachusetts, where last spring a group of physicians and nurses drafted a statement of concern about the health care system called, "For Our Patients, Not For Profits: A Call To Action." The statement warned of the devastating impact of profit-driven health care, and warned that in the new world of marketplace medicine "doctors and nurses are being prodded by threats and bribes to abdicate allegiance to patients and to shun the sickest."
Others soon joined us; our group now includes medical students from the University of Maryland, nursing students from Johns Hopkins, physicians in academia and private practice, community groups and individual concerned citizens. This fall, we collectively founded the Maryland Committee to Defend Health Care, and dedicated ourselves to creating an inclusive, empowering dialogue about the state of health care in Maryland.
The goals of the Maryland committee are to encourage a broad public dialogue about the future of U.S. medicine and firmly stand in the way of for-profit takeovers of Maryland's healing resources, the not-for-profit hospitals, nursing homes, clinics and insurance companies that have served Maryland citizens for generations.
To this end, we are advocating a statewide moratorium on the takeover of any Maryland not-for-profit health care institution by a for-profit company. For example, the Maryland Committee to Defend Health Care adamantly opposes any attempt by Blue Cross and Blue Shield of Maryland Inc. to convert to a for-profit institution or to form any entity that may bring its not-for-profit status into question. The not-for-profit institutions of Maryland were built over decades by taxes, charity and volunteer support, and we must continue to safeguard these indispensable community resources.
We are working to achieve these goals through several activities. We have initiated a series of public forums and debates designed to initiate discussion of issues that affect health care in Maryland, and to refine our strategy of working with elected and appointed officials as well as the officers of not-for-profit organizations to further our goals and to ensure the well-being of Maryland's health care system.
Five basic principles guide the Maryland committee:
Medicine and nursing must not be diverted from their primary tasks: the relief of suffering, prevention and treatment of illness and promotion of health. The efficient deployment of resources is critical, but must not detract from these goals.
The pursuit of corporate profit and personal fortune have no place in care-giving.
Potent financial incentives that reward overcare or undercare weaken doctor-patient and nurse-patient bonds, and should be prohibited. Similarly, business ar-rangements that allow corporations and employers to control the care of patients should be proscribed.
A patient's right to physician of choice must not be curtailed.
L Access to medical and nursing care must be the right of all.
These principles have attracted broad support: They appeared in the prestigious Journal of the American Medical Association on Wednesday, followed by the signatures of 3,000 physicians and other health professionals - the first of several thousand more who have endorsed the principles. Here at home, these principles won the endorsement of the first-year class of the Johns Hopkins School of Medicine - a truly historic feat considering that no Maryland medical school class has ever lent its endorsement to a political or social imperative.
We are attempting to achieve nothing less than a halt of the headlong rush to commercialize the practice of medicine in this country. We want to foment an active and inclusive public dialogue so we can formulate an equitable and caring vision of health care - a vision in which compassionate care for the patient is the bottom line.
This is not an issue that affects physicians alone, and it is not a darling of liberals or conservatives. This is a very human issue that will touch each of us.
Pub Date: 12/07/97