From the President...

Physicians Fire Back --- At Last!

Robert J. Cihak, MD

In the last issue, I wrote about the possibility and hope of top down Medicare reform. But there's even greater hope of reform from the bottom up. More and more physicians are seeing through the smoke and mirrors of the current managed care and government systems. Physicians in all parts of the country are firing their managed care plans and managers.

Many doctors and patients around the country are re-creating truly private medical practice. By cutting out the insurance company middlemen, doctors and patients do an end run around insurance company bureaucracies. The non-profit organization that originated in the Seattle area and many other independent doctor organizations around the country are developing parallel tactics. Doctors and patients deal directly with each other on the basis of trust, instead of each having an army of accountants, analysts, police and regulators looking over their shoulders and casting distrustful glances at the other side.

I dropped my health insurance when I found dealing with the insurance company was unhealthy for me; I now use the SimpleCare system. After I had one diagnostic procedure, I was ushered into the business manager's office, who totaled up what the Blue Shield plan would have paid, down to the odd penny. I asked if I could round it up to include a 10 percent tip, which was accepted.

Some don't have much sympathy for us "darn rich doctors." The terrible truth is everyone in the entire health care system, including patients, doctors, medical support staff and other practitioners, would be better off today if physicians, following AMA leadership, had not help create a monopoly system where only certain physicians are legally allowed to provide medical services. We physicians should have focused on the needs of patients a century ago, instead of selling our services --- and parts of our souls --- to the government in exchange for a legalized monopoly administered by state licensure boards and AMA commissions deciding how many medical school and residency training positions would be open. Later we auctioned ourselves off to insurance and managed care companies. Some very wise medical students saw the trends and decided to go into specialties with fates not dependent on or tied in with centrally-controlled hospitals. Perhaps this is why AAPS membership includes a high percentage of dermatologists.

It is jarring to think that hospitals are centrally controlled but they largely are. In order to open their doors, hospitals have to meet the requirements of state health and safety laws, for starters. In order to get paid anything at all for many of their patients, they also must obey tens of thousands of pages of Medicare and Medicaid regulations.

But many physicians didn't have the courage or knowledge to do what our hearts told us was right.

Yes, we physicians learned how to meet the medical needs of their patients with the latest in modern science in every conceivable specialty and imaginable subject. Patient demand, professional pride and competition keep most private physicians up to date.

Back before the medical financing system was frozen in time by flawed medical service plans and the government Medicare and Medicaid command-and-control systems, physicians met the diverse needs of their patients with equally diverse financing. Doctors accepted payment in the form of cash from some, of ham or eggs from others, or in a heart-felt and heart-warming "Thank You" from many patients who couldn't afford to pay with anything more.

Decades ago, we physicians should have overcome our own arrogance. We should have educated and recruited patients in the battle for medical freedom for all. Deceitful, grubby, self-serving, vote-buying politicians would have been less likely to enslave medicine if citizens had joined the battle between human freedom and central control. When faced with stark choices, such as the failed Clinton takeover of the entire medical system, everyone started to wake up; the attempted takeover never even came to a vote in Congress.

As many AAPS members have known for some time, there is simply no way centralized managed care can ever meet diverse patient needs. Although economist Milton Friedman figured this out decades ago, recent experience with rebellions by patients and physicians alike have taught lessons to even members of the media.

Rather than trying to play power games and "King of the Mountain," patients and physicians should have more choice and freedom. For example, many companies are giving up on trying to buy one-size-fits-all medical insurance for their employees. Instead, each worker has the choice of which insurance plan to buy and which doctors to see. They buy their health coverage with the funds previously paid to managed care companies. The fancy term is "defined contribution." Another variation on this theme is the Medical Savings Account (MSA).

The many courageous doctors offering direct service in exchange for direct payment are showing the rest of us how to free ourselves from some of our shackles. As Dr. Michael Aubrey of Ontario, Canada, wrote in the Medical Sentinel (Summer 2001), the key remains "for the profession to say, enough!"

Dr. Cihak is the President of the Association of American Physicians and Surgeons (AAPS), and a radiologist in Aberdeen, Washington. His column is distributed by and Scripps-Howard News Service.

Originally published in the Medical Sentinel 2001;6(3);81. Copyright©2001 Association of American Physicians and Surgeons (AAPS)