The American health-care system was built on physicians practicing independently or in small groups, with fees for service paid directly by the patients or their families. Nowadays, fee-for-service medicine is out of favor because it is viewed as inefficient, costly, and uncontrollable.
Actually, health-care costs are out of hand because third-party payers—government agencies, insurance companies, and employers—have chosen to change payment methods for doctors and hospitals without considering patient needs or medical effectiveness.
Such changes raise a question for Americans: “Whom would you trust more to make the right decision for your health, the secretary of Health and Human Services, the CEO of a health-insurance company, or doctors you choose and compensate?”
Third-party payers’ one concern—unrelenting upward pressure on costs—has continued. The result has been to disenfranchise physicians as professionals with the freedom to decide on the best ways to care for patients. Undaunted, the payers have imposed and expanded treatment paradigms on providers to reduce their flexibility and make costs more predictable. No other country requires that most routine medical practices follow preset guidelines. …
… If the U.S. system is to function more effectively and fairly for patients, doctors should be autonomous. The more that decisions about appropriate care are left to physicians and their patients and not to computer-driven paradigms or insurance companies whose profits are at risk, the better it may be for patients and our health care system.