I am pleased to see the revolt taking shape in the American people against HMOs and Managed Care. This is reaching such a momentum that now both political parties are addressing this scandal in the American health care system. A scandal that  has made some millionaires who are pocketing the money coming from the premiums from the hard working American citizens.

But this is a great democratic country. I am sure that we will end up doing the right thing and having health care for all Americans. I believe that a Single Payer, as in proposition HR1200, will best respond to the needs of the American people. The present US Health Care System is perverse and must go!

This is the question: should we go fishing? Instead of organizing ourselves to fight for what we believe, should we just go fishing and allow the health corporations to continue to take over the "market", and to make us, health care professionals,  their slaves? The FTC rules that we, physicians, can't organize ourselves to stand up against these greedy organizations. We are not even able to strike. The chairman of the FTC thinks that if we organize we will ONLY want to raise our fees... Money! Yet, our main concern at this point is NOT money. Is what are not being allowed to do when treating our patients because of the HMOs and Managed Care Organizations are anti-treatments!... Their profits depend on less care!.

What is worse? Some health care professionals, the "brightest" of course, are now  making groups and networks, "contracting" solo practitioners to work for them. They are thriving under Managed Care! Some are even offering a fee splitting scheme. The majority will hire psychiatrists only as "med-chekers" to please the MCOs. These groups and networks are getting exclusive contracts by offering lower fees. And they have convinced themselves that by doing what the MCOs want they are offering good medicine. Fools... nothing personal folks, it is the system that is perverse. This is why we must change it.

Perhaps we,  professionals who work with insured clients under Managed Care should start our own national association with branches in every state. How about an American Association of  Providers (AAP)? No! No entrepreneurs please! Only clinicians, thanks!

Some of my colleagues in psychiatry are trying to persuade me that the way to fight managed is not to work with "their" patients. That is, to work only with private patients who will pay out of pocket. I guess this could be one strategy but when I move in this direction I keep asking if this will allow for the universal access that a health care system should offer. These colleagues then tell me that they will use a sliding scale fee so that everyone will have access. I am not sure. In the past I have not seen this working very well. It seems to me that what the people want is to share the costs and have universal access.

Other colleagues, refuse to be in the panel of MCOs, but will treat their patients as "non participant providers". That is, the patient will pay their fees ($120? $150?...) and the Managed Care Organizations will have more profits because will pay less to the professional. Is this the way to go?...

For this and many other reasons I am in favor of a Single Payer System like in Canada. Of course I want to work in my noble profession and I love to offer good services to my patients. But I believe that I must go beyond this immediate interest. I must be able to look at the health care system and see what is best for the population of this great country.

This is why I am here trying to do something against the perverse health care system Americans now have!

Some friends have asked me if I saw a way, even remote, of working smoothly with MCOs while taking good care of my patients. I am pessimistic about this possibility because the system is perverse. If you award people  for denying treatments, it is impossible to expect that these people will be interested in offering treatments. But, in my presentation at the American Association Annual Meeting in Toronto (1998) I did mention certain issues that would have to be resolved before I would consider this possibility. Here are they!

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