Kyle R. Ver Steeg, MD
If private practice loses out to megacorporate medicine in the U.S. (i.e., "Clinton-lite" style), don't make the sloppy error of equating it to the corner grocer or hardware store losing out to Hy Vee or Wal-Mart. The small grocer lost out to the large corporation because he was unable to offer the same goods at as low a price as the large corporate entity.
Medical care is different. By its very nature it offers custom services, not goods. A large corporate entity can't operate any more efficiently than I can, for instance. In fact, not as efficiently.
How, then, are these megacorporations becoming so dominant in medical care? It's via the use of "camouflaged force," i.e., tax and administrative law, not efficiency. For example, if I wanted a possession of someone's, say, part of their wealth or income, I could capture and enslave them through naked force, or I could use "camouflaged force" and lobby the government, who through the force of law could (and have) required that one's income be "redistributed." The result is the same, but if you obey, you never feel the bullet or whip, or see the prison bars - but the threat is always there, its just camouflaged.
How has this "camouflaged force" worked to the advantage of megacorporations in U.S. medicine? Several ways come to mind:
1. The creation of employer-based health care through unequal tax treatment of money used to purchase health insurance.
2. Unequal application of antitrust law in health care. "Rule per reason" law is applied to large medical corporations consolidating their power. "Rule per se" law is applied to physicians, thus disallowing them to consolidate their power (unless they become employees of the consolidated megacorporate entities).
3. Unequal tax treatment of money used for capital expansion. "Non-profit" entities such as our hospital can set aside tax free, charitably donated money to grow tax free and be spent tax free for capital expansion. In the case of our local hospital, "capital expansion" consisted of the disgusting spectacle of lining the pockets of doctors with these charitably donated funds in return for their loss of autonomy.
4. "Certificate of need" laws, now under total domination of Iowa hospitals, are preventing any capital expansion by the doctors (except for a chosen few).
I never criticize even as bad a system as this is becoming without offering solutions: Read #1-3 again and replace the word, unequal with the word, equal. Accomplishing that in reality would put our system on the right track. #4 --- "Certificate of need" laws require abolishment. They fly in the face of a flood of empirical evidence that free competition is vastly superior in allocating resources. We can also do our part by remaining independent physicians. I recall the words of Benjamin Franklin that he who gives up a small amount of liberty for security deserves neither liberty or security.
We physicians are watching the health care system in America become very ill. Oh, it hasn't felt badly, yet. It is still delivering fine care. Doctors are making fine incomes. Remember, though, a patient with cancer doesn't feel badly until it's too late to do much of anything about it. You might say to me, "It's too late to do anything about it now." I say to you, "You'd better try like hell or the system you've come to love will die."
Dr. Ver Steeg is president of the North Central Iowa Physicians Association, Fort Dodge, IA 50501.
Originally published in the Medical Sentinel 2000;5(1):22-23. Copyright©2000 Association of American Physicians and Surgeons (AAPS)