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Reza Nabavian Headshot

Health Care Reform in the United States

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The discourse on the responsibility for health care delivery centers on this question: is access to health care an individual "right" or is it a "privilege"? What is not clarified in this question is from whose perspective is it being asked! In typical fashion, the pundits divide along the liberal vs. conservative way of interpreting any complex problem in our society. Instead of simplifying this issue into another hot topic like social security, abortion, gay marriage or gun rights, I suggest we break it down and analyze it from a higher resolution perspective.

From the point of view of a physician, it is in fact a "privilege" to care for another human being. If you read every single "personal statement" by every student who has ever applied to medical school, the pervasive theme is that of an individual who is intensely motivated to care for fellow human beings. I believe that this is a genuine feeling that helps a student put in the long hours of hard work over the many long years that it takes to become a practicing physician. Why else would these bright individuals enter such difficult and demanding line of work? Their cohorts studying business, law, finance, marketing, management, etc., seem to have found a much smoother and easier path to join the "1%". So from the standpoint of the health care provider, we have a work force that is smart, motivated and for the most part dedicated to the well being of others.

As a patient, I believe it is also a "privilege" to be cared for by a highly trained and caring physician. So if the "economics" were surgically removed from the equation, these two positions of privilege seem highly cohesive! This synergy is very evident in the dynamics of medical "relief" work. I can speak from my own experience working in Haiti in the aftermath of the recent earthquake. But the reality does involve economics and that bring us to the question of "right" to health care.

We may agree or disagree on whether "free market" is the answer to everything. The fact is some services such as "responding to fire emergency" may not have an intuitive supply-and-demand solution. So is the right to health care similar to the right to "fire intervention" or is it more along the lines of a right to housing, food or transportation. From the perspective of a physician, is there a right to free market competition when it involves the health of an individual? Does a patient have a right to the best medical care despite the ability to pay? It is the question of "right" that provokes strong emotions and reverts the issue back to the fundamental principles of capitalism vs. socialism.

With health care costs around 17% of GDP in the United States, it is time to seriously question the wisdom of "for-profit" insurance system. An insurance company has a conflict of interest with both the patient and the physician. It is time to eliminate it. This is not a question of personal "right" to income, care or choice. It is a question of the structure that mediates the patient-doctor interaction. While the government may be too inefficient to manage the country's health care system, a non-profit health care administration system may be the solution. There is a successful model for this in Kaiser Permanente health care system. While Kaiser is not the government, it is also not mandated to turn in a profit. It just needs to maximize its efficiency. The efficiency comes from having the highest number of members and participants. Imagine if the entire health care apparatus of the country was a united system operated by health care professionals to deliver the best care with maximum efficiency. The patients would have choice. The providers and the supporting industries would be adequately compensated. The system would be inherently efficient because there would be no impetus to take resources (profit) out of the system.

This is both our "right" and our "privilege."

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