Relman, a professor emeritus at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine
, offers his diagnosis of what has gone wrong with American health care, along with a radical solution. In clear, eloquent prose, Relman explains how the rush to commercialize medicine harms both physicians and patients. Contrary to free-market dogma, Relman asserts, in medecine the profit imperative "increases costs; it may also jeopardize quality or aggravate the system's inequity." Relman's proposal: a single-payer insurance program supported by an earmarked, progressive health care tax, coupled with a reformed delivery system in which all hospitals would be not-for-profit and most physicians would be salaried employees of not-for-profit prepaid group practices. Relman acknowledges that today's political reality doesn't favor his program. Instead, it is fueling the drive for so-called consumer-driven health care (CDHC); in theory, by forcing consumers to pay for their own health care (for example, through high-deductible catastrophic insurance), CDHC promotes more prudent choices. But Relman calls CDHC "an illusion that bears little resemblance to the realities" for seriously ill patients.. He predicts that in a decade or so, when CDHC has failed to solve the health care crisis, the country may be ready to try his plan. (May 23)
