Personalities: A Profession of Service

James W. Squires, MD, has seen the world of healthcare from several perspectives. From above as a U.S. Air Force flight medical officer, from the OR as a surgeon, from the inside as an HMO founder, and from the political realm as a New Hampshire state senator. He formed the Matthew Thornton Health Plan in 1971, New Hampshire's first. Squires is now the founding president of the Endowment for Health, a private nonprofit foundation dedicated to improving the health of the people of New Hampshire.

On creating the Matthew Thornton Health Plan: I began to wonder how would I ever be sure what I was recommending to a patient was strictly in their interest and not in mine. I thought it would be more comfortable for me as a surgeon to think about prepayment and set about to create a prepaid multispecialty group practice that would be not for profit and would be run by a board of directors selected from the community. Medicine is a service profession and, ultimately, the obligation should go to those to whom you're providing the service.

On the politics of healthcare: There's scarcely an element of any aspect of healthcare that isn't deeply embedded in the political process.

On what's wrong with U.S. healthcare: You have this triangle—cost, quality, and access—and it seems to me our balance among those three categories is not in line with every other industrialized nation. We are extremely expensive. We have enormous difficulties in getting access to healthcare, and there is a mountain of information that says that the healthcare being provided does not give superior results.

—Marianne Aiello