May 24, 2018
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One expert’s opinion on medical care

Philip Caper
By Dr. Philip Caper, Special to the BDN

The Bangor Daily News has given me the opportunity to write a monthly column about health care in America, with a particular focus on Maine. This is the first of those columns.

A columnist, unlike a reporter, is allowed to express an opinion. It seems to me that readers have a right to know a little about columnists in order to judge whether they should care what a particular columnist thinks.

I graduated from medical school in California in 1965 and migrated east to train in internal medicine at Boston City Hospital. I did basic cancer research at the National Institutes for Health for two years, and then returned to Boston for a fellowship in improving the delivery of medical care at the community level.

Although I received excellent clinical training in the care of individual patients, my career interest soon turned to how whole communities receive care. My first job after completing my training was as a professional staff member in the U.S. Senate, working on federal health care legislation for Sen. Edward Kennedy.

After six years in Washington, I returned to Massachusetts to serve as chief of the medical staff and director of a new teaching hospital in Worcester. Since then, I have held research and teaching positions at several universities in the field of health policy and management.

Toward the end of my career, I founded a small consulting firm that assessed patterns of medical practice in different geographic areas in order to help evaluate the quality and costs of the medical care being delivered. Our company was named by the Wall Street Journal as one of the 100 “outstanding companies of the future.”

So I have had the privilege of seeing the American health care system from a wide variety of perspectives — as a student, practitioner, researcher, federal policymaker, teacher, entrepreneur and — occasionally — patient.

My opinions have been informed by these professional and personal experiences. But they also have been shaped by my values. As a physician, I prefer to work in an environment that allows me to do what I believe to be in the best interests of my patients, no matter who they are. Therefore, I believe access to medical care should be the right of all Americans. My entire career has been focused on achieving these two goals.

But for some time, health care in America has been moving in the opposite direction, a trend that recently has accelerated sharply in Maine. Our medical care system almost seems designed to frustrate attempts by caregivers to provide the best care and efforts by patients to receive it. Every year, it seems, more Americans lack the financial resources to get the medical care they need and insurance companies think up more ways to deny payment for care.

I plan to use this space to write about why this is the case and what we can do to fix a health care system that is flawed in some fundamental ways. I will explore topics such as why health care should be a right throughout America as it is in all other wealthy countries; why medical care is so much more expensive here than anywhere else in the world; why we have so many uninsured people; and why so many doctors are frustrated and angry about the environment in which they practice.

I will explain why we are witnessing the extinction of primary care specialists, despite overwhelming evidence that we need more of them, not fewer. I will explore why we are seeing a shift in the health care “industry” away from diagnosing, treating, curing and healing illness and toward the creation of wealth for the producers of health care goods and services.

I have strong ideas about how we can begin to fix our broken health care system and make it work better for all of us. My views will surely provoke controversy. But isn’t the job of a columnist to stimulate thought and reaction? If I achieve nothing else, I’m quite certain I will succeed at that.

Dr. Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be contacted at

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