Altom Laura K, Churchill Larry R
Vanderbilt School of Medicine, Nashville, Tennessee, USA.
MedGenMed. 2007 Feb 28;9(1):40.
Discussion of universal healthcare is nothing new for US politicians or among reform advocates, policy experts, or the general public. Physicians, however, have been minor voices in the discussion. Their relative silence has been detrimental both to the public and to physicians themselves. We pose 3 arguments as to why physicians should support universal access grounded in medicine's own self-interest, arguments that are largely ignored in the current debate. These are: (1) the need for paying patients, (2) the need for a sense of self-esteem rooted in professionalism rather than commercialism, and (3) the urgency to affirm a public purpose for medicine by promoting the nation's health through universal care. Who has a stake in universal healthcare? Some groups, such as those lacking insurance, are obviously at risk and have a keen interest. Others, such as insured workers, have a less obvious but demonstrable concern. Arguments that urge adoption of an inclusive system typically focus on "healthcare horror stories" designed to evoke sympathy for the unfortunate persons whose lives are forever changed by unmet health needs or unpaid health bills. Our focus is different. We ask, regarding universal healthcare, "What's in it for physicians?" While the active support of doctors may not be a sufficient force to change the US system, it is probably a necessary one. At a minimum, universal coverage will be far less likely if physicians are opposed to it. Our aim here is to explore and discuss some of the reasons that should motivate active physician involvement in a more just and equitable system. We will discuss 3 reasons in particular. They are: (1) the need for paying patients; (2) the need to take pride in what one does--that is, the need to be nurtured by recognition of skillful professional performance in medical work, and not just rewarded monetarily; and (3) the importance of embracing a public purpose for medicine and thus engaging the trust and esteem of the population. We will examine each of these in turn, but first we will discuss briefly the other constituencies for universal coverage, since their reasons for supporting an inclusive system are often shared by doctors.
对于美国政客、改革倡导者、政策专家或普通公众而言，全民医保的讨论并不新鲜。然而，医生在这场讨论中一直是少数派声音。他们相对的沉默对公众和医生自身都不利。我们提出三点理由，说明医生为何应基于医学自身利益支持全民医保，而这些理由在当前辩论中大多被忽视了。这三点理由是：（1）需要有付费患者；（2）需要一种基于专业精神而非商业主义的自尊感；（3）迫切需要通过全民医保促进国民健康来确立医学的公共目的。谁在全民医保中有利益关系？一些群体，比如那些没有保险的人，显然处于风险之中且有着浓厚兴趣。其他群体，比如有保险的工人，其关切虽不那么明显但也确凿无疑。主张采用包容性体系的论点通常聚焦于“医疗恐怖故事”，旨在唤起人们对那些因未满足的健康需求或未支付的医疗账单而生活永远改变的不幸者的同情。我们的关注点不同。我们问，关于全民医保，“这对医生有什么好处？”虽然医生的积极支持可能并非改变美国医疗体系的充分力量，但可能是必要力量。至少，如果医生反对，全民医保覆盖的可能性将大大降低。我们在此的目的是探讨并讨论一些应促使医生积极参与建立更公正公平体系的理由。我们将特别讨论三点理由。它们是：（1）需要有付费患者；（2）需要为自己的工作感到自豪——也就是说，需要通过在医疗工作中熟练专业表现得到认可来滋养，而不仅仅是金钱回报；（3）确立医学公共目的的重要性，从而赢得民众的信任和尊重。我们将依次审视每一点，但首先我们将简要讨论全民医保覆盖的其他支持者群体，因为他们支持包容性体系的理由医生常常也有。
