The Doctor as Double Agent

TLDR

In the 1990s, American doctors were pressured to act as “double agents,” balancing patient care against rising medical costs stemming from an inflationary, open‑ended health‑care system that has evolved haphazardly since the 1920s. The study argues that reforming the health‑care system to eliminate inflationary pressures, rather than limiting care, is the solution to inefficiency. The authors conclude that continuing to ask doctors to withhold care to cut costs is unjustifiable and politically motivated, threatening the patient‑centered ethic of medicine.

Abstract

American doctors in the 1990s are being asked to serve as "double agents," weighing competing allegiances to patients' medical needs against the monetary costs to society. This situation is a reaction to rapid cost increases for medical services, themselves the result of the haphazard development since the 1920s of an inherently inflationary, open-ended system for funding and delivering health care. The answer to an inefficient system, however, is not to stint on care, but rather to restructure the system to remove the inflationary pressures. As long as we are spending enormous resources on an inherently inefficient and inflationary system we cannot justify asking doctors to withhold beneficial care to save money for third-party payers. Doing so serves a largely political agenda and endangers the patient-centered ethic that is central to medicine.