Setting new priorities.

A recent press release from the Medical Group Management Association asserts that medical rationing is here, to stay, so we had better get used to it. Dick Lamm, keynote speaker at the 98 MGMA annual conference in Denver and Governor of Colorado from 1975 to 1987, is quoted in the release as saying that there simply are not enough resources to give everything to everyone.

While it is not feasible to supply all citizens with unlimited healthcare, I urge MLO readers to challenge the notion that there is insufficient funding to supply better healthcare for more people. Our resources may not be as limited as we are led to believe, and our spending priorities may not be appropriate. I am not the only one who is suggesting that the interests of healthcare macroeconomics should not revoke the duty physicians have to individual patients.

William Rosenblum, MD, pointed out some disturbing similarities between health management in America and that of Nazi Germany (Viewpoint: Do no harm versus the greatest good for the greatest number. Clinical Laboratory Management Review. 1998;12(4):300;295-299.) Rosenblum identifies the willingness to sacrifice the welfare of a few individuals for the good of the many as the same justification used for the sterilization of 300,000 "feebleminded" German citizens - the result of a sterilization law passed to insure the integrity of the aggregate German gene pool.

The history of the concept of informed consent in clinical trials in the U.S. is also illustrative. The 1930 Tuskegee study in which American doctors lied to African Americans with syphilis, telling them they were enrolled in a free healthcare program while withholding treatment to study the natural history of the disease, was supposed to benefit the nation as a whole.

The goal of rationing in medicine for the greater good seems harmless enough at face value, but we must question whether the individual horror stories of healthcare denials are worth it. in our affluent society, it is ridiculous to accept that our resources are so limited that we must curtail medical care. The real question is whether we are willing to give up some degree of affluence (in the form of military firepower capable of obliterating whole nations, the big screen TV in the family room, or that Caribbean vacation) for a wider array of healthcare choices.

Rather than accept healthcare rationing as a fact of life, we need to reconsider our society's broader priorities for spending both public and private money and avoid letting an old rationale for improving the greater good lead us to repeat history.