Economic considerations continue to drive the issue of healthcare delivery. The rapidly escalating cost of health care and the growing number of uninsured persons are factors emphasizing the need for a decision on what to do to fix the currently broken system.

The cost and availability of health care will be major issues during this year’s presidential election campaign. I suspect that, regardless of the outcome of the election, major reform will be inevitable.

The role of medicine
Organized medicine will probably increase its efforts to be a major player in the debate, primarily by lobbying Congress. I anticipate that this approach will prove to be insufficient, for it ignores the fact that the “people,” not their alleged representatives in Congress, will have the final word.

More important is the fact that organized medicine has failed to respond to the challenges that have threatened the profession for some time and have now reached ominous proportions. Medicine has thus far chosen to concentrate on pocketbook issues, limiting its concerns primarily to the reductions in reimbursements for services rendered. Although these reductions should concern us, our representative organizations have ignored the pleas from both the government and the public for assistance in offsetting the disproportionate growth in the cost of medical care.

Rather than maintaining its traditionally high moral standards, medicine has rapidly lowered those standards and allowed the profession to slide into a business, with profit as its raison d’etre. Instead of capitalizing on new developments in technology that offer unprecedented opportunities for the betterment of the human condition, many have abused these expensive technological advances, seriously aggravating the cost of care. The abuse of technology, rather than its high cost, is the major culprit.

In medical subspecialties such as orthopaedics, which are technology driven by their very nature, a plethora of surgical techniques and appliances flood the market in a rapid succession. This single phenomenon has made possible the never-imagined current scenario whereby the manufacturing industry virtually controls the education of orthopaedists and dictates their research activities. The ongoing investigation conducted by the Department of Justice regarding ethical infractions, many of them criminal in nature, in the relationships between orthopaedic surgeons and the manufacturing industry eloquently testifies to the serious nature of the crisis in healthcare delivery confronting the nation.

Becoming part of the solution
The American system of healthcare delivery is broken. It is unjust, insensitive, unsustainable, and unaffordable. It must be fixed. The implementation of some type of universal health insurance is inevitable. If we—the medical and allied heath professionals—join together in offering support for appropriate reform, we must do so in a manner that reflects a sincere desire to be part of the solution, instead of being part of the problem. Unless we become members of the decision-making process, we may find ourselves in a situation where physicians, hospitals, and allied health professionals become government employees—an approach that is being considered by people in influential positions.

Some professionals may argue that universal health insurance will bring to an end the scientific creativity that has flourished for so many generations. Not true. Progress of scientific and technical nature has not declined in highly sophisticated European and Asian countries, despite the fact that in these countries, affordable medical care is given to all regardless of their financial well-being.

It behooves the medical profession to commit itself to participate in the ongoing debate and to offer its knowledge and expertise to create a humane and affordable system worthy of the high standards this country upholds. Removing the shackles that industry has so skillfully and effectively placed around our necks should be high on our agenda.

Dreaming that the status quo will remain unchanged and that the problems the country now confronts will solve themselves is wishful thinking.

Augusto Sarmiento, MD, is a past president of the AAOS.