有人说，医疗保健的结症所在是美国和中国都把医疗保健办成了盈利事业。换言之，医疗保健应该是种慈善事业，医院就该办成观世音菩萨的救苦救难的南海福利院。这还真有点共产主义思想闪金光的味道。

我们希望当医生的都是希波克拉第(Hippocrates)的弟子，象白衣天使，救死扶伤，天不分南北，人无论穷富，都是分文不取。把医疗事业不当成盈利事业，而当成普渡众生的慈善事业。把病人当亲人，送医送药上门，分文不取，可那样谁还来当医生啊? 猪八戒想常住女儿国、马克思要世界大同实现共产主义、Bush总统想抓住拉登宾，那都是些水中月镜中花，代表的只是理想境界。凡人做不到圣人的事，医生他也是凡人哪，是人就得吃喝拉撒睡，这都得要钱! 那又该谁给医生钱呢?

医院和医生都该盈利，这本身没错。错在他们不该追求超额利润，垄断医疗市场而不顾病人死活和社会利益。这就是为什么医疗市场需要政府干预管制，不让它放手成为完全的自由市场。中国和美国的医疗问题其核心问题都是市场垄断问题。美国当医生难，大学期间就需要十年左右，而且费用昂贵，一般人只能放弃当医生梦想，哪怕将来的金钱回收是那么的高。医生数量少了，医院就少，就没了竞争，因此就医费用就成天价。加上现在那该死的HMO组织和保险制度(有保险后，人们就医的频率加大，头疼脑热有事没事就泡医生)，更让费用水涨船高。到头来就没有穷人的好日子过。

中国医疗界也是垄断问题，尽管表现形式有所不同。医院说什么就是什么，给什么药做什么手术收什么费，根本没个谱。医院对病人封锁信息，欺诈做假甚至医疗事故致人以死都不用真正的负责赔偿，病人没其他地方咨询投诉，这都是市场垄断的表现。比美国更糟糕的是政府的干涉力软弱，甚至不加干涉还当帮凶，助长医院的垄断地位。比起民主社会，中国极权的国家政府力量按说能做到想干什么就能干成的地步，解放以来在共产党领导下中国人民所创造的奇迹般的伟大成就就是例证。但反过来，什么事在中国还没干成，就只能说明政府还不想干不愿意干。就医疗业改革来说，因政府和政府人员在现有体制中有巨大的利益，得到最大的好处，改了它也就等同于放弃或失去这份利益。与医生一样，政府人员共产党人都是凡人肉胎，追求的都是私人利益，这本身没错。但医疗改革失败，不能照顾好广大的人民群众利益，却正是因为政府不能也不愿意放弃自己的私利，他们再怎么强调改革的困难也都只能是借口。要不你怎能解释改革开放前中国就能建立一套相对行之有效的城市人人能就医农村也有赤脚医生这样的制度，而在财富上已经天翻地覆慨而慷的今天，中国的医疗事业却成了假药欺诈和医生成就发财梦想的乐园!

不过，也别忘了，赤脚医生虽然看病不要钱，哪儿都有而且人人都能看病，也就是说这种制度已十分接近非盈利的慈善事业，但他们病又看不好了，医疗质量十分低下。赤脚医生终究当不了观世音，菩萨有救病救灾的本事，可赤脚医生只有红药水紫药水。所以说，赤脚医生制度也只能是种失败的体制。在现在的中国作为改革方案来恢复赤脚医生制度，恐怕广大人民群众也不会答应。医疗改革是个难度极大的社会问题，答案恐怕要在赤脚医生制度和完全市场之间寻找。

附希波克拉第誓言 :

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

(中译文--摘自希波克拉底文集)

仰赖医神阿波罗埃斯克雷波斯及天地诺神为证，鄙人敬谨直誓，愿以自身能力及判断力所及，遵守此约。凡授我艺者，敬之如父母，作为终身同业伴侣，彼有急需，我接济之。视彼儿女，犹我兄弟，如欲受业，当免费并无条件传授之。凡我所知，无论口授书传，俱传之吾与吾师之子及发誓遵守此约之生徒，此外不传与他人。

我愿尽余之能力与判断力所及，遵守为病家谋利益之信条，并检柬一切堕落和害人行为，我不得将危害药品给与他人，并不作该项之指导，虽有人请求亦必不与之。尤不为妇人施堕胎手术。我愿以此纯洁与神圣之精神，终身执行我职务。凡患结石者，我不施手术，此则有待于专家为之。

无论至于何处，遇男或女，贵人及奴婢，我之唯一目的，为病家谋幸福，并检点吾身，不作各种害人及恶劣行为，尤不作诱奸之事。凡我所见所闻，无论有无业务关 系，我认为应守秘密者，我愿保守秘密。尚使我严守上述誓言时，请求神祗让我生命与医术能得无上光荣，我苟违誓，天地鬼神实共亟之。