Where MDs Fear to Treat
The American Medical Association (AMA) lost considerable credibility
during the Medicare Hearings in 1966-67. Organized medicine, as the American
Medical Association is often un-affectionately called, was quite antagonistic
to the legislation, and its representatives made statements that no official of
that organization woujld make today. They were
prescient in one aspect of their testimony however; namely that government
subsidy brings government control.
The control has accelerated as
rapidly as inflation and the government is controlling the entire health care
system to the extent that it is actually starting to ration facilities and put
a cap on the purchase of new equipment. It does this tentatively while gauging
public reaction.
Since most medical bills today
are paid by third parties (the insurance carriers), the public is in sort of a
bind. It finds that the third party payments are falling short of the rate of
inflation, which raises hackles; but the public doesn’t want to fuss too
vigorously with its benefactors because it fears that they might cut off
payments altogether which would be catastrophic.
Labor and industry are uniquely allied with government in
trying to contain the costs of medical care because medical care has become a
fringe benefit in labor contracts. Industry has to provide it. If industry can
cut the cost of medical care its labor contracts become cheaper. If labor can
cut the costs of medical care it becomes easier to win fringe medical benefits.
As a result, with government,
labor and industry allied in the quest for cheaper health care the health care
industry is effectively regulated. Hospitals are restricted by state licensure
and Medicare-Medicaid regulations. Doctors, a licensed profession, are
considered to be beneficiaries of what is called a legislatively granted
monopoly; thus the rationale for controlling doctors.
In this environment the AMA has
all it can do to stay organized. Doctors who are salaried by institutions,
universities or government feel no need for the AMA. They are a protected
species. Doctors in practice might glean some benefits from the AMA but the
benefits are hard to define and for the most part constitute a delaying action
against the encroachment by various forces. The government for one is currently
seeking to establish competitive groups within the medical profession. The
media relishes the medical scandal business and takes pride in showing off the
money grubber, the mal practitioner, the Medicare cheat and tends to ignore the
other 399,000 doctors who make sick people better. Malpractice litigation and
large awards have become so automatic that it is no longer necessary to prove
malpractice, all that must be shown is a poor result or an injury for a jury to
award plaintiffs
megabuck verdicts.
In the face of all this, the AMA
and its constituent state societies are virtually helpless. The AMA is
struggling for membership, confusing itself with a new code of so-called ethics
and joins its enemies in conferences calculated to water down unfriendly
legislation, but no longer has the wallop to change the direction of events.
The profession of medicine is fast becoming regulated to a degree second to no
other industry. The
I have been obliged of late to
participate in county and state medical society activities and must ruefully
confess that they are in a “no win” position. The forces arrayed against the medical medicine are
enormous, moneyed and well organized. The bureaucracy has nothing more to do
but to trifle with medical matters and organize the health care industry. It is
their full time job. Industry and labor hire full-time administrators to put
their medical houses in order; but the medical societies alas function on the
overtime energy of practicing physicians. The doctors are attending to their
political business part time, overtime, on weekends. Everyone else is full
time.
The medical societies are
overmatched. Doctors collectively are not good at lobbying, not good at
legislation, not wise about litigation and not even aware that most of the wars
they are fighting have already been lost.
As a result the medical societies
accomplish much less than that which the public credits them, and some are
reduced to chowder and marching clubs, brassy perhaps, but useless.
The public must learn to judge
the doctors on their performance as doctors not
as politicians; and by the same
token must understand that those that legislate health care cannot heal a sick
child.
The real purpose of medical
societies is to maintain the highest standards of medical practice and this
they seem to have done. Perhaps if they stop parading as politicians the public
will accept them for what they are – practicing doctors. No machinations, no
hidden motives, no political axes to grind, onlys one purpose; to cure, to heal to succor to
preserve to help.