American Health Care

by Benjamin F. Fuller

"There is great concern about health care in America and all are interested in the costs and complexities. Many plans for change are suggested. With a lifetime of practicing and teaching medicine, Dr. Fuller explains the need to reconsider responsibility to the patient. The magnitude of changes in the practice of medicine in one professional lifetime is not often fully appreciated. Enthusiasm generated by the new discoveries has not been matched by a willingness to learn how to use them effectively. There is no doubt that the health care system in the United States needs to be carefully examined and changed, but the health care plans have a common weakness - while all plans are strong advocates of using primary physicians in a leading role, none of them show an understanding of what the role of primary physicians should be in modern medical practice. They only view primary physicians as "gatekeepers" to be used to control utilization by controlling access more or less arbitrarily.^ The