With increasing public expenditures for health care services, the accountability of the health care industry has become a major political issue. Concomitant issues concern the structures and processes through which the public as patients, customers, and citizens can directly influence the delivery of health care services. These issues, which are currently part of the national health policy debate, are indicative of the larger question concerning the relationship of the individual to his increasingly complex society.
This paper presents three arguments. (1) The medical profession, through its control of technology and its monopolistic hold on legitimate claims of expertise, is the primary determiner of the way health services are structured and resources are allocated. (2) Domination of doctor-patient relationships, medical care delivery organizations, and the national health care policy process, enables physicians to remain unaccountable to democratic institutions and insulated from public participation in decision-making. (3) Lack of accountability, disproportionate professional power and the failure of governmental regulation raise questions about the role and impact of the medical profession as a quasi-institutional political actor in terms of (a) the return on the investment of $135 billion spent annually for medical care, (b) claims of expertise and self-regulation, and (c) overarching democratic values.