To: Herc who wrote (9 ) 9/27/1999 11:34:00 AM From: William L. Oppenheim Respond to
Where are you located. Academic Centers have it tougher because the case mix is often sicker, more poorly nourished, and more expensive, and because of the added expense of residents, and training in general. Now, they also seem to be run by folks, who instead of protecting what has been hard won in medicine--namely the patient doctor relationship, privacy, and the drive toward excellence--now have capitulated to the concepts of medicine for the masses, even if quality suffers. They say they have to compete with the HMOs on an equal basis, so they have no choice. They try to constrain the production of specialists, even when all of know that when having our mufflers replaced, we should go to a muffler shop, not the corner gas station. They buy up local practices and put their signs all over town, and they duplicate the same advertising as their competitors. Every dollar spent there is one less available for treatment or new facilities and technology. They emphasize volume over quality. Never mind that a large part of our economy has profitied by exporting our medical advances to the world. A sign of the times. It will take a generation or two to get over this, as it did in the more social countries when the medical system was allowed to gradually run down. And people will have to get a lot angrier first. The Hipprocratic Oath (? teacher's pet mentality) states that we must take care of those who present to us, but these companies circumvent that by taking advantage of those of us who believe in the Oath, and by refusing insurance to those who can't pay in the first place. I believe that one cannot turn a patient away, but we don't have the same obligation to a company. They are the ones who have a contract with their patients, not us. Unfortunately, Congress had tilted the game in their favor by refusing to allow us to organize and confront these entities for what they are. For-profit entities where every dollar of denied care winds up boosting their stock on Wall Street, where the real profits are made. They control access as well as the actual treatments which are available, and the doctors and patients are not allowed to hold them accountable. ERISA and anti trust acts protect them even as they create separate classes of individuals with different rights to recourse. Congress created these issues and now will itself be held accountable to solve them. Don't hold your breath.
