The terms hoodwink and boondoggle are so appropriate. My comments here were inspired in large measure by Dr Michel Accad's Jan 2009 insightful blog entry from which I quote:
'... beyond ignoring the obvious tension between the individual and the group,hoodwinking physicians into practicing "population medicine" is of course the essential means to confuse practitioners into thoughtlessly carrying out sweeping intervention whose primary benefit is the profit of third parties."
to this I add : and the profit-not necessarily in monetary terms-of the academics whose writings give a scholarly veneer to this monumental hoodwinking enterprise.
See here for Dr. Accad's entire essay,
In this regard several terms and concepts are important: population medicine, physicians as stewards of finite resources,cost effectiveness research and high value care. The key idea is to establish the notion that medical resources is a collectively owned resource and all are entitled to it by virtue of their existence. From this follows that the utility of the aggregate matters and not that of the individual and that some one has to manage this collectively owned resource and the elite medical progressives are the self nominated candidates for that job.
The medical progressive's claim to being egalitarian advocates of social justice is contradicted by their advocacy for a utilitarian approach to the allocation of these finite resources. Utilitarianism is not a subset of egalitarianism.A leading egalitarian, John Rawls accurately characterizes utilitarianism as being inattentive to the separateness of individuals and treating people merely as means for the achievement of some aggregate or social end. The medical progressives claim to promote social justice in the abstract but operationally sponsor utilitarian calculus in which some individuals may suffer from some alleged statistical benefit to the collective. The progressives play the social justice card frequently in their polemics profiting from this polymorphic notion's lack of generally agreed upon specificity - the term social justice is loose , vague and indeterminate.
The medical progressives causally dismiss the notion of rationing by their unilateral re-definition which excludes the limiting of "low value" care from their universe of rationing. Rationing according to this formulation means only limiting high value care and they presume they will be the arbiters of what value is high and what value is low.
Another linguistic trap is to speak of a given medical expenditure as a "cost to the system" rather than an exchange. So when someone goes to the ER with chest pain or severe headache that is considered to be a cost to the system or even more ridiculously a drain of resources rather than providing a service for a fee and the transfer of funds as part of various exchanges that are part of the ER medical encounters.
When someone goes to a car repair shop to replace a radiator or visits a barber for a haircut why do we not speak of draining the car care industry's resources or depleting the finite hair care resources?It is because to a large degree we are paying for the medical care with someone else's money It is the third party payers and their academic facilitators that have accomplished a monumental hoodwinking of the public and most of the medical profession by distorting the language of medical care and shifted the emphasis from a long standing oath based imperative to care for the patient to one of limiting care the effect of which is to benefit the third party payers
The language of medicine has been transformed into the language of medical collectivism and the third party payers owe a large debt to the efforts of the collectivists in medical academia and to some of those individuals in influential leadership positions of certain professional medical associations.
In support of the claim that many physicians have been hoodwinked is the amazing amount of support from professionals medical organizations for the passage of the so-called "doc-fix" or MACRA which mainly replaced one centrally planned system of price controls with another such system , one that placed even more control of medical care in the hands of federal planners and administrators and some "thought leaders" who have arisen from the leadership of various national medical organizations with important input from the lobbyists from the "Bigs" (big pharma,big hospital, big insurance,etc)
In closing I quote Dr. Accad again with this masterful summary:
" But beyond ignoring the obvious tension between the individual and the
group, hoodwinking physicians into practicing “population medicine” is
of course the essential means to confuse practitioners into
thoughtlessly carrying out sweeping interventions whose primary benefit
is the profit of third parties. Only clever sophistry can claim to
reconcile the needs of patients with the profit margin of insurance
companies, the bottom line of hospital administrators, the
end-of-the-month income of practitioners, the annual reports of
employers, the promises of legislators, the zeal of government
regulators, the self-importance of academics, the confused intentions of
voters, and the pocketbooks of taxpayers. The term “society” simply
conceals the myriad of interest groups that partake in the boondoggle we
call the health care system."