It is the free mind and individual responsibility, the principles of the Renaissance that have brought us the wonders of modern health care through the free-market capitalist system and through the inventiveness of the free minds it has raised. It seems we are now going to harness the capitalist engine for rationing....

The world owes all its onward impulses to men ill at ease.
The happy man inevitably confines himself within ancient limits.

Nathaniel Hawthorne (1804-1864)

On Managed Care And Cutting-Edge Technology

If you asked most physicians in the past what one thing characterized their profession, the most likely answer would have been fierce independence. Unfortunately, this is no longer the case. We have been and continue to be battered from an all-out assault of collectivist forces that infest our society and the legal profession that drains our substance. As a result of this assault, we have become daunted — lot, leaderless, frightened, and overwhelmed with a sense of helplessness and doom in the face of sundry forces working tirelessly to affect our demise.

As state and federal bureaucrats are busily working to force government-owned patient (Medicare and Medicaid) into managed care organizations and passing laws subsidizing and providing unfair advantages to HMO companies, one thing seems to have been totally forgotten — the patient. While some HMO CEOs are taking home salaries in the $15-$20 million per year range, the patient is getting short-changed in the medical care they have been led to believe they would receive when they enrolled. Managed care is based on lies.

Assisted Suicide/Euthanasia

At least two (and soon, possibly three) decisions in the spring of 1996 have boosted the forces pressing for the legalization of assisted suicide an pushing us down the slippery slope of active euthanasia.

In order to solve a problem, its root cause must be recognized and understood. This prevents falling into the trap of simply implementing or substituting another error.

Most of us who have examined the managed care system have spoken about the evils of “corporate medicine.” We have done this because the managed care system is set up, to all intents and purposes, as a corporation. But, a recent article appearing in Transaction Social Science and Modern Society changed my thinking about this most important subject.(1) The article was written by Caroline Poplin, a graduate of the Yale Law School as well as a practicing internist.

Medical care delivery is currently undergoing rapid pivotal changes in this country. Since the defeat of the Clinton national health plan, the “market” has taken over and managed care has become the sweetheart of the health care reformers. Believed by politicians, businesses, and patients alike, to be the answer to rising medical costs, it is being welcomed by all with zealous advocacy. As potentially important as this movement may be to these groups, however, there is one group to whom these changes may mean its very demise, the physicians.

Dear Dr. Gervais:
Thanks for your note of February 29, which was forwarded to me by Ophthalmology World Times. You posed a few questions.

Village Care and KidCare — “A Good Start?”

In this modern era of moral relativism, where one can justify doing nearly anything to anyone, where does one turn for advice on ethics in medicine? Well, right here in the Medical Sentinel, of course, but what about those who have not yet discovered the AAPS?

Dear Sister St. Joan:

Thank you very much for taking the time to speak with me. As promised, I’ll put some thoughts to paper from 30,000 ft.

We know that we can’t predict the future. Certain things, that were inevitably supposed to happen, didn’t.

France was supposed to become a part of England. Whoever would have thought that an illiterate peasant girl would become the youngest person to hold the rank of general in the history of the world and would save France?

You know, it’s bad enough doctors have to deal with the complexities and pervasive bungling of the HCFA/Medicare bureaucracy, but what do you tell your patients when they ask you to explain an Explanation Of Medicare Benefits (EOMB)? In an attempt to provide you with the skills you will need to rise to such an occasion, I offer the following true story as a test of your “Blue Bungler IQ.”

Case History

Dear Jeremy,

In your recent letter to me, you asked: “What do we do to protect our residents and residency programs, and ourselves as the teachers?” The answers to this problem are complex. But clearly, we must start with some basic physician behavioral modifications, if we are to secure any protection for medical education in this country at all, to say nothing about protection of our patients’ rights!

Much of what has appeared in the press and in medical literature concerning managed care has centered on various and sundry horror stories of denial of care by managed care companies and the resultant patient suffering. The talk, of course, is about greedy physicians, hospitals, etc., to the detriment of the patient. Certainly, some of this is true. The nature of HMO/Managed Care reality is, from beginning to end, denying medical care for profit.

Richard Epstein, a Professor of Law at Chicago University, opens Mortal Peril with a scene from ABC’s “Nightline,” in a telecast originating at Chicago University on February 6, 1992. The topic for this town meeting was universal health care. Ted Koppel presided at the center table with five carefully chosen experts on health care. Behind him in successive tiers were five more rows of health care officials and politicians.

Kudos to Dr. Curtis Caine

The Mississippi Society of Anesthesiologists recently honored Dr. Curtis Caine, a long time AAPS member and Medical Sentinel editorial board member. On May 1, 1998, Dr. Caine celebrated the 50th anniversary of his practice of anesthesiology in Jackson, Mississippi. His colleague and AAPS member, Dr. Alan R. Peeples writes: “This is a monumental achievement, and in recognition of this occasion, I would like to invite all of Dr. Caine’s friends and colleagues to attend a reception in honor of this milestone.”

Dear Editors,

One-seventh of the U.S. economy continues to be threatened by actions normally attributed to a socialist government. Managed care, encouraged by the Nixon Administration through economic incentives and special legislation, is now in the final stages of taking over America’s medical care delivery system. However, its fundamental modus operandi — denying medical care for profit — is becoming more and more apparent to the American populace.

Dear Editors,

In reading a copy of the 1908 book by G.K. Chesterton, Orthodoxy, I came across a quote that seemed applicable to today’s inattentive physician. In the chapter entitled, “The Eternal Revolution,” he states, “We may say broadly that free thought is the best of all the safeguards against freedom. Managed in a modern style, the emancipation of the slave’s mind is the best way of preventing the emancipation of the slave. Teach him to worry about whether he wants to be free, and he will not free himself.”1

I am a psychiatrist who works in a solo private practice in Burlington, Vermont. I do not belong to any managed care network or insurance plan, nor do I participate in any utilization review process. Each patient pays me at the time of each visit; if his or her insurance plan does provide reimbursement for non-network physicians, then the patient submits the claims. My patients are not fabulously wealthy. My annual advertising budget consists of $132 for a one-line listing in the yellow pages. I do not have a specialized “niche” practice.

These books, The Lost Art of Healing and The Healing Touch, discuss the nature and role of the patient-doctor relationship, the mounting administrative and organizational dangers to it, and how to address those dangers. The relationship itself, according to Dr. Kerr L. White, former deputy director for medical affairs of the Rockefeller Foundation, “seems to account for about half of the benefits associated with medical and other health professions’ ministrations.”

Nurses, Doctors, and HMOs

In case you have not heard, the managed care industry has instituted another divisive measure that is bound to cause resentment within the ranks of medicine: Oxford Health Plans, Inc. and Columbia Presbyterian Medical Center have struck a deal to assign primary care status to nurse practitioners who will be paid at the same rate as physicians.

The October 2, 1996 issue of the Journal of the American Medical Association (JAMA) was devoted to the theme of managed care. I wonder how many people noticed the title of the painting on the front cover? The painting is by Max Beckmann and is titled “The Sinking of The Titanic.” How fitting!

In April 1996, I resigned my position as the President of the California Chapter of the National Association of Managed Care Physicians (NAMCP). The main reason for this action was the fact that the NAMCP and its publication Managed Care Medicine (MCM) are guardians of the status quo in managed care.

Achey breaky hearts, stolen hearts, betrayal, love lost, and love gone wrong...country music loves misery and country music has it all. But, the queen of country music is singing a new tune these days. Miss Tammy Wynette says forget about “Stand By Your Man”; better stand by your medical records instead.

Dear Editor,

I am a managed care physician, not by choice alone. Your editorials such as “The Managed Care Malignancy” by Vernon L. Goltry, M.D. are too one-sided. The world of medical care is not black and white. The “private sector,” which had generations to perfect its modus operandi, has to accept some irresponsibility, primarily for its lack of leadership and control.

Much has been said about the importance of market competition reigning in health care costs. It has been stated the turnaround in costs has been in large part due to the managed care evolution, if not revolution. Indeed, managed care companies, especially Health Maintenance Organizations (HMOs) loudly trumpet their part in restoring cost control through free market competition. A close analysis of the cycle of events concerning market forces and managed health care, however, tell a much different story, particularly from the patient’s perspective.

No wonder physicians are demoralized, leaving the profession early, and joining labor unions. They are being enslaved by managed care masters and HMOs, while the concept of managed competition is destroying the medical profession. Yet, it's the American public, all of us as ultimate patients, who have the most to lose.

The year is 2025. In an attempt to understand the tragic demise of American medicine in the tradition of Hippocrates, we look back on the course of events around the turn of the century.