Doctors Unite?
Robert Pitofsky
Chairman of the Federal Trade Commission
If you are covered by a managed-care plan and get sick, who do you want to control decisions about health care procedures: your doctor or the insurance company that supervises the plan? Almost all would answer they want their doctor to decide, and they are upset-even outraged- at the extent to which executives preoccupied with cost containment have intruded into the decision-making process.
My comment: Nice way to start, recognizing what is happening to doctors and patients in this country Mr. Pitofsky. Perhaps you are in the position to do something about it.HMOs and other managed-care approaches first came into existence because health care costs were spiraling out of control and there was (and is) a legitimate need for containment. But now doctors complain that HMO managers have injected themselves into every detail of medical practice.
My comment: How come a competent man like you forgot to mention other important reasons why the managed care for profit approach came into existence? For instance, millionaire salaries/stock options for its CEOs and great dividends for its investors? Should we be silent about these realities?Perhaps the balance of power between HMOs and other managed care plans in one hand, and doctors and other health care professionals on the other, does need to change.
My comment: Perhaps Mr. Pitofsky? Why this "perhaps" when you know how revolted the doctors and patients are in this country? Suggestions?... I would love to hear your ideas on changing this balance of power between doctors/patients in one hand and the managed care industry in the other.Unfortunately the decision of the American Medical Association to endorse creation of a bargaining unit that will allow doctors in the future to bargain collectively with HMOs is the wrong answer to a serious problem
My comment: Well, what other answer could you offer for this “serious problem”?...Many doctors who are employees already can join unions.
My comment: So... if a doctor is employed this is not a wrong answer... Hmm, you then agree that they can join an union and fight for what makes sense to them in terms of remuneration, conditions of work and their patients' interests. But not if they are "providers" for managed care for profits. Interesting...But the National Labor Relations Board consistently has held that self-employed doctors - just like self-employed lawyers, architects and accountants - are “independent contractors”, and not laborers.
My comment: Now Mr. Pitofsky did you ever hear of people buying insurance to access lawyers, architects and accountants? And these self-employed professionals working under some form of managed care? Is the majority of the American people moving towards having insurance benefits under managed care for lawyers, architects and accountants? It made sense that when doctors were indeed self-employed private doctors charging patients out of pocket they should be subjected to antitrust laws as are lawyers, architects and accountants. But health care in this country is changing. Doctors have less and less choice but to join the insurance/managed care industry because the majority of the American people also have no choice but buy insurance to protect them and their families. Also, you forgot to mention that the antitrust laws don't seem to apply to these health corporations that have been setting doctors fees, condition of work and medical procedures in order to maximize profits for themselves and for the employers who contract with them.Collective bargaining by competitors eliminates price and quality competition, and can be a conspiracy to fix prices or a boycott that violates anti-trust laws.
My comment: You seem to be living in the past Mr. Pitofsky. As I tried to explain above, fewer and fewer doctors can now practice medicine like lawyers, architects and accountants. If they want to treat people they have to become "providers" for the insurance/managed care industry or else change profession (like many are doing...).Right now, nothing prevents doctors from joining forces and advocating to insurers or employers who hire those insurers that some decision by an HMO affecting health care procedures is wrong. If doctors want to go beyond advocacy to bargaining, they can organize joint ventures- such as a clinic- and the antitrust laws would pose no threat.
My comment: I am not sure what you mean here Mr. Pitofsky. Advocating to insurers and employers with what kind of leverage? How starting a clinic with a group of doctors going to do this?. Please advise...If they don't want to join forces with other doctors in a clinic and are upset about quality of care decisions, they can individually quit the HMO and go to some other HMO that they think is more reasonable on quality-of-care issues.
My comment: Do you truly believe that doctors can pick and chose their HMOs. Where have you been? Have you seen the insurance and managed care mergers and how many choices doctors and patients are having now and will have in the future? Why are you allowing for these mergers and acquisitions so that the choices for doctors and patients dwindle?Finally, it is doubtful whether the antitrust laws are really a threat even to independent doctors who join forces to bargain with HMOs on behalf of patients.
My comment: I am going to save and file this statement Mr. Pitofsky. I may need it in case I decide to form a physician's group to bargain with HMOs on behalf of my patients and the doctor-patient relationship. In order to please you I will never mention money or fees even if I keep receiving these nice letters from the health care industry telling me that my fees have been reduced..The American Bar Association examined antitrust enforcement actions over the past 20 years and found that every one was aimed at efforts by doctors to increase their incomes rather than represent their patients on quality-of-care issues.
My comment: I would love to hear more details about this. When they occurred, in what context, and how the health care scenario was at the time.Some might respond that if the government isn't bringing any antitrust cases challenging joint negotiation to improve patients’ quality of care, what is wrong with clarifying the situation with an exemption?
My comment: Very good question.The answer is that the exemption that is proposed is overkill. It would allow doctors to boycott HMOs that do not pay then 10 or 20 percent more money.
My comment: Hmm... I thought you said “negotiation to improve patients’ quality of care”.If that happens, employers forced to pay more are likely to curtail coverage, patients will pay more through copayments, and as a result the number of people not covered by health insurance (now about 43 million) will increase.
My comment: Any ideas about why these numbers? It is also because of the doctors?... Love to know your answer.It will also allow doctors to get together and boycott lower cost but also worthwhile alternative forms of health care. There is a long history of successful antitrust challenges to doctors who acted through hospitals and health care plans to keep out nurse midwives, psychologists and podiatrists.
My comment: I guess this could have happened. But because this may have happened, doctors, should forever have no bargaining power?...History indicates that while most doctors would not misuse an antitrust exemption, some would with unfortunate results for all.
My comment: So, we in this great democratic nation will not make laws when a minority may not use it right? I guess we should not have deductions in the IRS because a minority of tax payers misuse it?...So what is the answer, if you assume as I do that HMOs and other insurers play a legitimate role in controlling excessive costs, but have assumed too much power over the practice of medicine?
My comment: Mr. Pitofsky how come you don't give us YOUR opinion? Why are you pushing this on the reader?I believe the answer is for Congress to pass a strong Patient Bill of Rights proposal I have seen provides that doctors and their patients who believe has made a wrong decision may request that the decision be reviewed by an individual or group that is independent of the doctors and HMOs.
My comment: Who will pay these reviewers Mr. Pitofsky? The patients? The doctors? Managed Care? The Government? After the patient is dead? Just asking. You also did not mention why these business should be protected from being sued unlike what happens to all businesses in America.The goal ought to be to give doctors and other health care professionals the ability to reassert control over their professional lives, but not give them a license, alone among all professions in this country, to do little more than increase their incomes by engaging in price fixing.
My comment: You are again talking about doctors as if all of them are still in private practice charging people out of pocket. Why? I would agree with you if you qualified that doctors in private practice charging patients out of pocket can't unionize. But doctors who are "providers" for the insurance/managed care industry? They are being treated worse than employees. They have no rights, thanks to people like you.Traditionally, unions are organized to increase salaries and improve working conditions for members. They do not usually bargain over the quality of the product that their members produce. If quality of care is the goal, then a union is the wrong prescription.
My comment: Doctors are human beings like everyone else. You said that employed doctors should have this right. You are denying that the modern relationship between doctors and the insurance industry is not the same as doctors as self-employed private practitioners charging out of pocket. You are also forgetting that, unlike other professions, the doctors do have -by motivation and by law- to be concerned with the quality of their work.The Washington Post (only the article of Mr. Pitofsky)I believe that considering the health care scenario in America, the doctors are not left with any other choice than form unions. I go a little further than the AMA. They ought to be able to strike, provided that this will not affect the well being of their patients.