Overzealous efforts to hold down health-care costs threaten to turn medicine "into a public utility, over-regulated and under-responsive to the needs of individual patients," C. Everett Koop, the former surgeon general, said yesterday.
"Cost-control should not mean remote-control medicine," Koop said. "We must restore the healing bond of trust between doctors and patients."
When you visit your doctor, there are only the two of you in the room but often there is a third presence far away whose opinion may govern the doctor's actions, said Koop.
Koop, the keynote speaker at the opening session of Greater Baltimore Medical Center's three-day, 25th anniversary medical conference, said that in an attempt to control Medicare costs, the federal government has hired private firms whose job it is to second-guess doctors' decisions in order to cut costs.
Getting rid of mismanagement, waste and fraud in health-care costs is essential, Koop said. But he is "deeply disturbed and even frightened" when this is attempted by "misguided interference" in the doctor-patient relationship.
Koop, 74, left the surgeon general post last October after nearly eight years on the job.
Koop proposed establishing a commission to "elucidate the problems, deal with them piecemeal and within a decade bring about some improvements."
He said the commission has to include doctors, insurance people ("because they are the most threatened") and Republican and Democratic members of Congress who would be required to attend meetings.
Koop would like to see national health insurance to provide access to basic care for the nation's 2 1/2 million "uninsurable" -- those who can't buy insurance because they are considered bad risks and have serious health problems that need attention.
Poverty lies at the root of most of the nation's public health problems -- drug abuse, acquired immune deficiency syndrome, alcohol abuse, malnutrition, smoking and communicable disease, Koop said.