Arnold Relman

Arnold S. Relmanis professor emeritus of medicine and of social medicine at Harvard Medical School and the former editor of The New England Journal of Medicine.

Recent Articles

In Dire Health

Despite the passage of the Affordable Care Act, the U.S. medical system is near collapse. What will save it is a single-payer system and physicians in group practice.

M ost people assume that insurance is an essential part of the health-care system. Some think it should be provided through public programs like Medicare, while others prefer to see it purchased from private insurance companies, but the majority believe that insurance is needed to help pay the unpredictable and often catastrophic expenses of medical care. That is why so much public policy focuses on extending coverage to as many people as possible and controlling its cost. I think this emphasis on insurance is mistaken. We would have a much better and more affordable health-care system if the reimbursement of medical expenses through public or private insurance plans was replaced by tax-supported universal access to comprehensive care, without bills for specific services and without insurance plans to pay those bills. Insurance is not simply a mechanism for spreading financial risks and paying for medical care. Because it usually tries to limit payments to providers, insurance often...

Canada's Romance with Market Medicine

C anada, of all places, is having a highly charged national debate about whether to adopt the U.S. model of commercialized health care as part of its national health-insurance system. Health policy makers in Canada, particularly at the provincial level where most practical decisions are made, are being told a monstrous myth. Consultants and business people, often with little professional health training or experience but with ample conflicts of financial interest, are extolling the advantages of marketplace medicine and the benefits that an American-style entrepreneurial approach would supposedly bring to the stressed Canadian system. And yet the U.S. experience of the last two decades and the evidence on the performance of for-profit health insurance and medical care tell just the opposite story: Entrepreneurial markets have made a shambles of our health-care system. Any nation seeking to follow the U.S. example risks the same failures now plaguing the United States. A committee of...

State of the Debate: Dr. Business

A new book by a Harvard Business School professor who wants to reorganize medicine into "focused factories" shows just how scary the medical-industrial complex might become.

WORKS DISCUSSED IN THIS ESSAY George Anders, Health Against Wealth: HMOs and the Breakdown of Medical Trust (Houghton Mifflin, 1996). Regina Herzlinger, Market-Driven Health Care: Who Wins, Who Loses in the Transformation of America's Largest Service Industry (Addison-Wesley, 1997). You can buy any linked book through our associate program with Amazon.com H ealth care remains one of the most intractable domestic problems facing the United States today. To compound the issue, there isn't even agreement on what health care really is, or what it ought to be. To most physicians, like me, it involves at its core a professional relationship between patients who are sick or injured and the physicians to whom they entrust their care. But to a business school professor, like Regina Herzlinger, it is a "service industry," the products of which ought to be selected by consumers (let's not call them "patients") in a competitive marketplace, on the basis of price, convenience, and quality...