Copyright 1999 The Buffalo News
The Buffalo News
June 26, 1999, Saturday, FINAL EDITION
SECTION: EDITORIAL PAGE, Pg. 2C
LENGTH: 720 words
UNIONS AND DOCTORS
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
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.
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.
June 27, 1999