By Drs. Glueck and Cihak
What do you call a few good women physicians in San Jose, California, fighting back against managed-care plans?
* A good start!
* A late start!
* Too little, too late?
* All of the above!
We choose all of the above and commend these doctors for their courage long absent from American physicians.
The headline of a June 12 bizjournals.com article raged, "Managed CareUpdate: Physicians Strike Back In Heart Of Silicon Valley." Scott Holleran, an independent journalist, wrote "a new group of physicians in San Jose have declared war on managed care plans, such as HMOs and PPOs, by demanding payment and the MDs are winning." Holleran was commenting on a June 12 article by Troy May in The Silicon Valley/San Jose Business Journal. May notes, "Silicon Valley Women's Health Medical Group was formed in February when a number of smaller groups, frustrated by declining reimbursement rates, came together to form their own OB/GYN practice" of 29 physicians.
Now, we know most of you don't have much sympathy for those darn rich obstetricians. The terrible truth that many don't want to hear is that everyone including you the patient, the entire healthcare delivery system, the hospitals, clinics, medical schools, nurses, technicians, therapists, podiatrists, optometrists, dentists, and physicians all would be better off today if the physicians had fought back 20 years ago. But they didn't have the courage, the know-how, leadership, or an effective organization.
Physicians had many specialty, subspecialty and continuing medical education organizations at the local, county, state, national and international levels. There were excellent scientific medical journals the classical and new in every conceivable specialty and imaginable subject. The docs did a good job in this regard. Professional pride and intense competition kept most physicians up to date on the latest advances.
There were also many medical political organizations at all the same levels. Infected with self-interest and individual self-promotion, they did little to represent all physicians. They also did not understand the art of advocacy like the attorneys who understood politics and the power of afew strong organizations like the American Bar Association (ABA) or the American Trial Lawyers Association (ATLA), not that we think physicians should behave that badly!
By contrast, The American Medical Association (AMA) has done a poor job in representing patients and physicians. Some of their fiascoes like "Sunbeam" and the CPT code (medical billing) incident have alienated the general public and physicians alike. The AMA lost more than 3,000 members and $4.2 million in revenue from membership dues last year, continuing a decline that began several years ago. That puts membership at 290,357, or only about one-third of the nation's 800,000-plus doctors, residents and medical students. Likewise, during the past two decades, the editors of most "prestigious"medical journals rarely, if ever, took a strong stand on managed care until it was too late. Heaven forbid they might offend someone!
One of these two writers had a spirited ongoing mail exchange with a recent past editor of the New England Journal of Medicine. He encouraged the editor to speak out. A few months later, the editor finally wrote an editorial on the Journal's "right to speak out on controversial issues."But in the same editorial, he spoke out on no substantive issue other than his right to speak out. After many months of silence, the same editor, one month or so before he retired, spoke out delicately on managed care far too little, too late!
Many big medical journals even advocated Soviet-style rewriting of historyto conform to the then political correctness of cost-cutting managed care. For example, practices unacceptable to most physicians such as drive-by baby deliveries and extremely short hospitalizations after major surgeries became the topics of articles in some journals. The academic researchers, writers and editors sold their souls to political correctness to obtain government grants!
Twenty years ago, we physicians should have done the following:
* Instead of tens of thousands of medical organizations, physicians should have established one or two good organizations. Of course, this would have meant that not every doctor would have had a big title like president, vice president, director, chief, editor in chief, associate editor, ad nauseam.
* We should have found a few good generals and lots of troops not 100,000 generals and no combat-ready troops.
* Physicians should have overcome their own arrogance and joined with other medical personnel, groups and organizations, as listed above. The deceitful, duplicitous, self-serving vote-buying politicians would have been less likely to strangle what was once the world's best healthcare system if there had been one medical organization of 10,000,000 that had the courage to stand up for their patients. (Notice, we did not use the term "union" nor would the organization needed to have been a union.)
The tincture of time has proven what was obvious at the start: There is no way that either non-profit or for-profit managed care can now or ever could provide more, better and faster care when middlemen managers and executives take out 20 to 35 percent for themselves. Although economist Milton Friedman figured this out decades ago, you no longer need to be aPh.D. economist to know what's going on!
Funny how until recently mainstream press writers and editors conveniently failed to notice or comment on the hoax of managed care which was then and is now really "managed cost"! Again, the 90 percent liberal media bought into the concept of political-correctness rather than the correctness of the truth.
Holleran also writes, "Now only government bureaucrats, career HMO docs and dinosaur business executives seriously assert that this hybrid of socialized medicine is and ought to be the wave of the future. ..."
Physicians, as a group, needed more heart, more courage and a better brain-set in the late 1970s, 1980s, and 1990s. We needed more action and fewer acronyms. Ironically, this inaction is from a profession that preaches early diagnosis and treatment. "A stitch in time saves nine" goes the old saying. From a group of 800,000 physicians, we couldn't seem to sew one good stitch!
As we went to press, the ever watchful Holleran alerted us that a new poll (released June 18) by CNN-USA Today and Gallup, reveals HMOs are the least-trusted institution by Americans. HMOs ranked last in the survey below the institution that passed the HMO Act: Congress. What this means is that the people understand malevolent-care, even if Congress does not!
We applaud and praise the Terrific 29 from the Silicon Valley Women's Health Medical Group for showing us the way to do what the profession should have done 20 years ago. Let's hope it is not too late for all the horses and all the men and women to put Humpty Dumpty together again. We pray that this happens soon in our lifetimes before we get really sick.
Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes extensively on medical, legal, disability and mental health reform. Robert J. Cihak,M.D., of Aberdeen, Wash., is a nationally recognized healthcare policy analyst. Both doctors are Harvard-trained diagnostic radiologists. Collaborating as The Medicine Men, they write a weekly column for WorldNetDaily as well as numerous articles and editorials for newspapers, newsletters, magazines and journals nationally and internationally.
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