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Copyright 1999 The Buffalo News  
The Buffalo News

June 26, 1999, Saturday, FINAL EDITION


LENGTH: 720 words



The doctors who want to bargain collectively with health plans say their primary interest is in patient care, not higher pay. If that's the case, a tough "patients bill of rights" may be more effective than a doctors' union in achieving that goal. It certainly would be worth trying before the more radical step of unionizing medicine.

Despite doctors' claims of wanting union power to be more effective advocates for patients, unionized medicine could easily wind up being the wrong prescription for health-care consumers and taxpayers. It could drive up health costs, thus making insurance so expensive that some companies may simply opt out of coverage, exacerbating the problem of the uninsured in this country.

With its vote to reverse a long-standing position and endorse the concept of unionizing, the American Medical Association is capitalizing on the public backlash against managed-care plans -- a backlash sometimes based more on rumor than fact.

But where managed care has gone overboard in the bid to stop spiraling costs, a substantive "patient bill of rights" still mired in Congress is the remedy that should be tried first, if patient protection is the real goal.

Instead, this vote puts the AMA seal of approval of efforts by doctors who work as salaried employees of governments, hospitals and health plans. Those physicians -- about one-seventh of all doctors -- already can organize, and many already have.

But the movement eventually could affect all doctors. Texas just implemented a law that allows all physicians to organize. And a bill in Congress by Rep. Tom Campbell, R-Calif., would do the same thing nationally, letting doctors in private practice bargain with health plans just as workers in any field bargain with employers.

Currently, professionals working independently -- as doctors in private practice do -- would be guilty of collusion if they engaged in such practices. But that hasn't stopped some from trying -- and therein lies the danger to consumers and taxpayers.

The Federal Trade Commission cites example after example of physicians who've tried to band together to take on health-care plans. Often the area of contention was physician payment and the FTC had to step in with consent orders to stop doctors from engaging in thinly disguised boycotts if more money wasn't forthcoming.

"An across-the-board antitrust exemption would allow all doctors in a community or all members of a particular speciality . . . to band together and insist they be paid an additional 10 or 20 percent," FTC Chairman Robert Pitofsky warned Congress the other day.

Even though the Campbell bill would bar "any collective cessation of service to patients," it would not stop doctors from simply refusing to contract with a given health plan that failed to meet their fee demands. And while most areas have a choice of health plans and rely on competition to keep premiums down, doctors on the other hand could form a virtual monopoly.

The worst-case scenario could leave businesses facing higher premiums. Consumers would face higher co-pays and deductibles, and perhaps fewer benefits as the cost of health care shot up. And taxpayers would pay more as the costs of care for government workers increased, and Medicare and Medicaid got hit with increased costs.

Good doctors have a personal interest in their patients' health. And many physicians have voiced heartfelt concerns about having to jump through managed care's bureaucratic hoops after long being the sole arbiters of appropriate care. But the potential for unionized doctors to be primarily concerned with curbs on their income remains too great to ignore.

U.S. health-care costs already are exorbitant, compared to other leading nations. Most of the "horror stories" about managed care's efforts to stem that price spiral concern for-profit plans, not the non-profit type that exist in Western New York.

But to the degree that any of the plans have gone too far, empowering patients with the right to sue, better HMO report cards and more ability to choose one health-care option over another offers the most promise.

Congress should pass a comprehensive patient bill of rights and give that a chance before taking the radical step of letting doctors bargain like autoworkers and longshoremen.

GRAPHIC: Associated press Delegates attending the American Medical Assoication's annual meeting show their support for a doctors' labor union to negotiate with health plans.

LOAD-DATE: June 27, 1999

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