Bush v. Kerry: Who Forgot Physicians?

For months I considered writing about the 2004 presidential election. The political event of the year certainly could not be ignored in a column that preaches the importance of political activism for physicians.

But what value could be added to the millions of words already written? To help me figure that out, I decided to read the healthcare plans President Bush and Sen. John Kerry have posted on their Web sites. (You can check them out, too: www.johnkerry.com/issues/healthcare/Families_Plan.html and www.georgewbush.com/HealthCare/.)

What I found surprised me.

Both men offer detailed ideas with few surprises. Each wants to reduce healthcare costs, make the system more efficient, improve patient care, and ease the medical malpractice crisis.

But while comparing the plans, it occurred to me that the candidates have very different views of the role of physicians.

Bush sees healthcare as a private business, between patient and physician. His plan is based on a simple premise: everyone should be able to choose a plan that meets their needs at a price they can afford. This is accomplished by expanding the depth and breadth of tools like Medical Savings Accounts and tax credits, encouraging the return of fee for service.

Kerry's primary focus is on ensuring that 95 percent of Americans, as well as 100 percent of children, will receive healthcare coverage. He does that through a variety of rather complicated mechanisms.

The cost -- at least $653 billion -- would be paid by repealing many of the Bush tax cuts. But as I re-read the Kerry healthcare plan, I realized something was missing: Physicians.

Except for a discussion of medical malpractice, physicians are mentioned only in passing references, and then as one of several players in determining patient outcomes. In Kerry's healthcare world, physicians exist implicitly, only as "providers" within the explicit world of "lawyers, insurers, and employers."

Certainly the Kerry plan is not the only place physicians are lumped in with all "providers." But in the complicated healthcare world envisioned by Kerry's plan, physicians are seemingly unimportant and invisible. Patient outcomes improve; efficiencies materialize; all without physicians. Just an oversight? In Bush's healthcare world, physicians play a leading role: As he explains: "We must reform healthcare in America ... giving patients more options, fewer orders, and strengthen the doctor-patient relationship."

Healthcare is likely to undergo significant changes in America during the next decade. As those changes take place, many determined by government policymakers, physicians must be vigilant in not allowing themselves, once again, to be relegated to a secondary role in healthcare. Physicians must insist on a primary role in determining treatments, medications, and reasonable outcomes. Physicians are more than just "providers." They are the most highly skilled healthcare professionals in the world, and must be treated accordingly.  

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Practice." E-mail me at at
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This article originally appeared in the July/August 2004 issue of Physicians Practice.