The role of the physician in the delivery of health care has always been accepted as the primary role.
Over decades physicians have come to view themselves not as public service workers but as entrepreneurs entitled to command astronomical fees. They are in business. Everyone needs a physician at some time in our lives. Sickness is their business. Most argue that they should be rewarded financially because of their high skill levels and the cost of their education. The costs of medical school are extremely high. The more specialized the field the higher the costs.
So how does a physician come to view himself as an entrepreneur rather than a public servant whose area of expertise is to intervene and work with communities to prevent illness and maintain health. Not too many physicians involve themselves in the area of health prevention. Certainly this is part of their practice and when you visit the doctor’s office you may get advice on the need for proper diet and exercise and ways to reduce stress etc. But in the main this is left for other health care providers. That same physician who advocates better diet and more exercise –does not involve himself in the question of whether or not his patient can afford a better diet, whether or not he has access to exercise, if he has shelter or if the stresses of trying to survive and raise a family are the main source of the stress that has been proven to be one of the main causes of poor health and illness.
Health and health care cannot be extracted from other aspects of our lives. If you were to ask a physician what is the relationship between public vs private education she will probably look at you and wonder. Ask another MD what they feel about private garbage collection or the privatization of community facilities like rinks and gyms, libraries etc. If you really want to bewilder most physicians, ask them what they think the relationship is between their work and the work of the cleaning staff in their OR. Or what about the issues of race and gender, poverty and unemployment, shelter and the health issues pertaining to the millions of working people who have has their homes stolen from them. Ask an oncologist what his social relationship is to the corporations who pollute the water and air. Ask him or her about the health of migrant workers and their children. Of course most of us would not have enough time to ask our physicians these questions or to involve them in this sort of dialogue. Time is money after all for business people.
Health and the delivery of health care is a social and political issue. It is related to every aspect of our lives. We could take every one of the questions mentioned above and relate it to health and health care.
Generally physicians view their role a politically neutral when it comes to these social and economic issues. At the same time they know they are not the least neutral when it comes to the debate around public vs private health care. Physicians in the main will fight tooth and nail against the idea of being salaried public servants.
In Saskatchewan Canada when Medicare came into effect, the majority of physicians went on strike.
In Cuba education for physicians is free. In Venezuela when Chavez and his supporters began the work to constitutionally empower and resource poor communities, there were not enough Venezuelan physicians willing to work in the Barrio Adentros , community clinics based in the barrios offering free health care to all. Cuban physicians were imported to staff these clinics initially. Gradually by offering free and improved education at all levels to Venezuelan working and poor people, including access to free medical school education , more and more Venezuelan physicians were educated to be public servants working in communities , not apart from but deeply involved with the people in the barrios and communities. Poor and working people were to a huge extent for the first time empowered to collectively determine their health care needs, and make decisions around the allocation of financial and human resources required to begin to meet theses needs. This kind of radical , broad approach to health care , health and illness viewed as social issues , health care providers working with and empowered by the communities they serve is of course a serious threat to capitalism and to the physician as entrepreneur.
The debate around health care is larger and more complex than it appears. Underneath the arguments of who pays is the larger reality that health is a collective social issue and responsibility that can only be addressed within the context of radical social and economic change where working people together own the resources and collectively and democratically administer and the allocation of these resources social issue and concern. Radically changing health care means radically changing the whole political and economic base of society. Health and health care is a collective social issue and responsibility related to every aspect of social and economic lives.
Keeping the discourse around health care in a silo unrelated to the debates around education and poverty , racism , jobs , salaries , benefits and pensions, child care and housing etc , is a fatal mistake . Health care workers in unions and communities can organize with working people everywhere to address these issues. The resources of the trade unions should be spent on outreach to communities of working and poor people, on the creation of workplace committees t to establish committees and assemblies in communities. The work should be done across sectors. The links between the fight to preserve and enhance free public education at all levels is directly related to health and the fight for public health care. The same goes for the fight for jobs and pensions and benefits and public services.
The battle for accessible and affordable public transit is connected to the fight for good health. There is no such thing as a single issue fight or campaign in the fight for a genuinely public health care system.
No comments:
Post a Comment