Health Care as a Commodity: Competition should be focus of health reform, lecturer says

ORLANDO, Fla.—Donald Palmisano, Esq., MD, believes the key to curing the health care crisis in the U.S. involves respecting the sacredness of the doctor-patient relationship and capping the size of malpractice awards.

In his keynote address at the Triological Society’s Combined Sections Meeting held here Feb. 4-7, Dr. Palmisano, who served as the 158th president of the American Medical Association from 2003 to 2004, asserted that the U.S. offers “the best medical care in the world,” and that many of the problems with access to medical care “are due to government intervention in the practice of medicine.”

While viewing health care as a market commodity best exchanged through a private contract between doctors and patients, Dr. Palmisano argued that the free enterprise system provides the best protections for such contracts. “The doctor-patient relationship can only exist in a system where doctors and patients can have freedom of choice through the selection of each other,” Dr. Palmisano said.

The doctor-patient relationship can only exist in a system where doctors and patients can have freedom of choice through the selection of each other.
—Donald Palmisano, Esq., MD

Dr. Palmisano, clinical professor of surgery and medical jurisprudence at Tulane University School of Medicine in New Orleans, said problems of access to health care could be solved by an expansion of free enterprise principles. People who cannot afford health care should receive tax credits to buy private health insurance, for example. “Here’s the way to fix the current system,” he said. “You allow the purchase of health insurance across state lines. You allow tax credits—whatever you pay for your insurance comes back to you as a credit, not a deduction. You allow private contracting between patients and physicians without penalty. You allow individual ownership of a policy and enhanced medical savings accounts. Get people off of Medicaid. Get rid of that program. Give [Medicaid recipients] a voucher and allow them to buy health insurance just like the people in the federal employees’ health benefit program.”

Despite widespread public support for Medicare, Dr. Palmisano considers it “a failed system” that shortchanges doctors and interferes with the private contract between the doctor and the patient. “If you treat a Medicare patient, and the patient says, times are tough, can you forget the co-pay, you can’t do that,” he said. “That’s illegal because that’s considered fraud. Also, if the patient wants to give you $20 more because the payment for you is not adequate, you can’t accept that. They kick you out of Medicare for two years. When you tell the public that, they say, ‘You gotta be kidding me! Why should there be coercion?’”