There’s no doubt that society is becoming more communal. “Giving back” has become so prevalent a saying that it’s near cliché. And even McDonald’s is posting on its walls a quote from its uber-successful founder, Ray Kroc, that “none of us is as good as all of us.”
As much as I think this is a crock (sorry, Ray) and that those who tell us that “it takes a village” want to be the mayor of it, I’m wise enough to know that these trends hit society every so many decades and that as much as I might rail against it, trying to stop it it would be like trying to push back against the ocean’s tide. As Franz Kafka said, “in the struggle between yourself and the world, back the world.”
Okay, this certainly explains the push toward hospital-centric healthcare, because hospitals are viewed as communal institutions. But this certainly doesn’t explain why nonphysicians should be running hospitals.
If the philosophical underpinning of Stark and other prohibitions on “self-referral” as well as of the federal anti-kickback statute and its state counterparts is the belief that money is evil and that it is wrong to profit from referrals, then why create exceptions to permit hospitals to profit in the new world of ACOs?
And, why should hospitals be run by nonphysicians? If a committee at Community Memorial Of My Local Town controlling its wholly-owned medical group is going to make a decision on rationing care to me, I want that committee to at least be made up of physicians, not of two physicians and five bean counting MBAs.
It will be decades until society swings back away from “it takes a village” to “it takes a strong individual” and the price we’ll pay in the interim will be rationing, death counseling, and other warm and fuzzy attributes of a so-called communal society. Heck, this makes its opposite, the so-called “greed” of rugged individualists, seem timid in comparison.
But as long as we’re on this communal swing, there remains the opportunity to dress the argument in communal clothes while advocating that those actually trained in delivering medical care should be the ones overseeing it.
Prohibiting for-profit hospitals and even nonprofit hospitals run other than by physician control from participating in Medicare, Medicaid or any other federally managed or financed health care programs wouldn’t be any more discriminatory than prohibiting new physician owned hospitals from participating in Medicare, as is the case under current law.
After all, the purpose of this suggested new approach would be improving patient care, delivering it in a more effective and efficient manner, all while reducing costs.
Who could argue against that?