From the President...

Do You Believe in Fairy Tales?

Robert R. Urban, MD

This is the story of a young man who believed in himself and in the American system. After high school and a two-year hitch in the army just after World War II, he worked his way through college and medical school, married his high school sweetheart, completed his training, and found the small town of his dreams. As a family physician of the fifties, he treated sore throats and infected ears, he mended bones with his hands and a fluoroscope, and over the next fifteen years, delivered more than fifteen hundred babies, without specialists or high tech, including one set of beautiful, healthy triplets. He welcomed the challenge of the whole spectrum of medicine, from the simple cold to the heart attacks and cancer. He never became wealthy, but he and his family always lived comfortably. His income was derived initially from $2.50 office visits, $5 house calls, and $50 deliveries (which included pre and postnatal care with or without complications, and complete care of the baby for six weeks including circumcision). Those modest prices enabled him to pay off a $5000 "start up practice" loan within the first eight months of practice. One year later, he was able to purchase acreage in the country near his practice for a future home. In another year, he was able to purchase his office building, and four years later, constructed a beautiful home.

Was this a fairy tale? Not at all. Was this an extreme case? Not in the least. Were patients satisfied with the care? They couldn't be happier. Was the physician content with his lot? He was known to say he often felt guilty because his vocation felt like a lifelong vacation. So how could this be? How could today's world be so different? The answer --- the physician worked hard, including many eighteen hour days and frequent nights in the delivery room. But most importantly, his government was small, taxes and regulations were minimal, and he earned real dollars. This gave him incentive to work hard, produce much, and receive a full day's pay for a full day's work.

Today, we call this phenomenon "The Free Market." In the fifties and early sixties, this system was working at its best. No, this was not a fairy tale --- this was real. Is it gone forever? Only if we allow it to be. How can we get it back? It would be naïve to ignore the political mountains to be climbed in order to solve the entire socioeconomic challenge we face today, but I can speak in regard to the health care aspect, because that is what I know best.

After forty-five years of practice, looking back to those golden years, and having watched collectivism slowly erode our system, I see one bright light regarding health care financing. It returns the power, the options, and the rewards back to the patients and physicians of America --- and that is --- the concept of the Medical Savings Account (MSA). I am convinced that if the government would butt out of medical care and allow this concept to further evolve, we would see a concomitant devolution of managed care: Vast sums of money, now wasted on a totally unnecessary industry, would be diverted from multimillion dollar CEO salaries back to patient care; the current egregious lack of care and rationing of care now seen with HMOs would no longer exist; patients would once again be in charge, and the once sacred patient/physician relationship could be restored.

As I write this, Congress is sitting on legislation that could change the entire future of medicine. We can all help this to happen by contacting our congressmen now --- today, urging them to move ahead with pending legislation that would remove the current onerous restrictions on Medical Savings Accounts, providing a truly American, free market solution for this American health care dilemma.

Yes, it can happen, and it will happen, if you and I will pick up that phone, write that letter, fax or e-mail that message. Better yet, visit your legislator, look him in the eye, and say, "Vote yes for that proposed legislation that will allow Medical Savings Accounts to work for all Americans."

A fairy tale? You decide.

Dr. Urban is the President of the Association of American Physicians and Surgeons, founder and past president of the Society for the Education of Physicians and Patients, and practices medicine in Belle Vernon, Pennsylvania. His e-mail is:

Originally published in the Medical Sentinel 2002;7(1);7. Copyright©2002 Association of American Physicians and Surgeons (AAPS)