Arthur Lurvey, MD, reminds the members of the Orange County Medical Society (OCMS) that the waiver of Medicare deductibles and copayments requirement is unlawful and violates the anti-kick-back statutes. Although it may appear that the waiver of the 20% copayments and deductibles helps Medicare beneficiaries, several studies have shown that if patients are required to pay even a small portion of their care, they become better health care consumers who select items or services because they are medically needed rather than simply because they are free. . . . Looks like a good principle for the HMOs to follow. Or are they not interested in patients controlling their costs?
Don McCanne, MD, also of the OCMS, discusses the AMA endorsed Breaux-Thomas Medicare premium reform. He questions whether we really want to inflict this change on our patients. Although cloaked in political language, it is, McCanne feels, a voucher program for the purchase of a health plan in the private sector or traditional Medicare. It is marketed as competition that will provide more health care for less money. He states that unfortunately, the objective data available indicate that the opposite is taking place.
The AMA recommends funding Medicare with private savings. McCanne feels this would bring an end to the concept of social insurance and that we should not accept reform which caters to the healthy and wealthy as it impairs access for the sick and poor.
The AMA also recommends replacing price controls with price competition. McCanne asks, “Where have our leaders been? The market, with unending megamergers, has become anticompetitive.” The AMA supports changing Medicare from an entitlement to a defined contribution program. He feels this can only increase the financial burden on the patient, often impairing access to care. He feels organized medicine has always advocated for the interests of our patients. These trying times should be no different. We must accept cost containment as a permanent reality. The managed care industry has impaired both choice and access, while the ranks of the uninsured grow exponentially. We need to demand that everyone receive high-quality comprehensive care provided by the traditional private and public health care sectors, absent Wall Street. He concludes that physicians need to return to the altruistic role of being the primary advocate of the best medical care possible for our patients, constrained only by availability of resources, not by a corporate mentality that understands only profits, not patients.
Gerard W Frank, MD, the new president of the Los Angeles County Medical Association (LACMA), began medical school at age 33 after having started a career as a physicist. Being the elder statesman of his class presented challenges but as his career advances. His age also allows for a unique perspective. A pulmonologist at White Memorial Hospital, Frank says the time has come for the Association to forge new relationships and partnerships with people and organizations that just a few years ago may have been perceived as outsiders or competitors. “In every aspect of my life, I’ve always learned more from people outside my immediate world than from people inside my world, and I think LACMA has to be the same way. We have to start listening to what other people have to tell us.”
The American College of Physician and the American Society of Internal Medicine have recently announced that 23 leading medical societies have denounced mandatory “hospitalist” programs.
There was an articulate interview of the new Sonoma County Medical Society President Cynthia Bailey, MD, in the Sonoma County Physician. (A number of the county medical societies seem to have new presidents who start in July.) She is another budding scientist-turned-physician who seems to have a grasp on medical issues. As to women in medicine, two-thirds of the women physicians in Sonoma county are members. Bailey advocates curriculum changes in academic medicine to allow more flexibility during women’s reproductive years. She understands MICRA and the implications of losing it, the importance of the continued ban on the corporate practice of medicine so we aren’t controlled by corporations, the maturing of managed care, capitation, the problems in dermatologic referrals, the future of private medicine, increasing patient responsibility, and how patients should be allowed to choose private insurance and apply the HMO premium and only pay the difference. . . . I think we’ll hear from her again.
Sonoma County Physician also devoted an entire issue to teenagers with featured articles on physical abuse; guns and gangs; the psychological profile–where is the depth in being an adult?; teenage sexuality and heartrending stories showing their lack of reality; adolescent nutrition and its impact on growth and pubertal development, diabetes, obesity, dyslipidemia and cancer; and adolescent drug abuse. Managing editor and fellow member of the American Medical Writers Association Steve Osborn, has again put together two very timely, professional, and high quality issues.