Other Points of View
Which Medicine, Which America?
N Engl J Med 2009; 361:e106November 12, 2009
- Article
Underlying the debate over health care reform are two competing visions of medicine. According to one vision, medicine aims to care for people in their communities and to provide affordable health care that counterbalances the effects that inequities of income and opportunity have on populations' health. According to the other vision, medicine is a collection of technologies that bring longer, higher-quality life to those who can afford them.
If we choose this technological medicine, which is the direction an unregulated market is taking us, we are choosing a health care that focuses on individual health, a world in which we have consumers and providers, long life spans for some — and, in all likelihood, a persistent and growing divide between rich and poor, as the medical services economy enriches the shareholders of corporations at the expense of the public pocketbook, continuing the pattern of the past 20 years.
If we choose community medicine, we are choosing a vision of community — local groups of people living interdependently1 — that is out of step with U.S. demographic reality, in which 80% of Americans live in metropolitan areas and local economic interdependence has been eclipsed by a world marketplace supported by new technologies.
As Congress debates ways of paying for health care, physicians would do well to understand that the choices that lie before us are the nation's choices and that we are charting a new course for both the nation and the future of medicine itself.
Michael Fine, M.D.
Health Access Rhode Island, Foster, RIThis article (10.1056/NEJMopv0909478) was published on October 28, 2009, at NEJM.org.
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