Comments on: IS THE AMA TRYING TO MUZZLE YOUR DOCTOR? http://www.healthcarebs.com/2010/05/09/is-the-ama-trying-to-muzzle-your-doctor/ Cleaning the Augean Stables of the Health Care Debate Thu, 10 May 2012 21:39:40 +0000 hourly 1 http://wordpress.org/?v=3.3.2 By: z9z99 http://www.healthcarebs.com/2010/05/09/is-the-ama-trying-to-muzzle-your-doctor/#comment-459535 z9z99 Mon, 10 May 2010 02:19:35 +0000 http://www.healthcarebs.com/2010/05/09/is-the-ama-trying-to-muzzle-your-doctor/#comment-459535 There is a reason why AMA membership is dwindling, and it is not merely that an increasing number of physicians disagree with its positions. Like AARP, NAACP, Amnesty International, the Sierra Club, and the American Bar Association, the AMA has come free of its moorings and drifted away from the purposes of its founding, and been comandeered by the ideological vanity of its blinkered mandarins. There is a unifying phenomenon underlying the rot of once useful institutions, and that is that there are some political issues that are too important for principles. Airy and unrealistic ideals seduce officials away from real solutions to difficult problems by appealing to the arrogance and conceit that are the noserings of the petty functionary. The AMA allowed itself to develop interests apart from those of its members, and as a result betrayed one and forfeited the other. The AMA took its reputation as an effective advocacy group too seriously and ended up being conned out of it by low grade political grifters. But there is something more at work here, and anyone who is curous about he future of healthcare should notice it. The role of patients and physicians is changing, possibly to the detriment of both. In days gone by, a patient sought the services of a physcian, who provided them in an arrangement confined to those two parties. The system consisted of the doctor and his or her patients. From a system perspective, it was reasonable to think of "the doctor's patients," and direct system improvements to this local level. Then insurance companies and HMOs started manipulating provider panels, and constructing their own networks, leaving patients to confront the possibility that their doctor of choice would be dropped from the network. The model thus became one in which these were no longer the doctor's patients, but the insurance company's patients that the doctor was paid to care for. This model has lasted about thirty years, and during this time, the authority of physicians and their organizations have waned in influence. The next wave is now breaking. Hospital groups like HCA, and Banner Health are taking over physician groups, employing physicians in convoluted arrangements, so that now the model views "healthcare consumers" as the hospital's patients that doctors are expected to treat with allegiance to their employers. Physicians have now slipped another rung, and the primary place that they once held in the healthcare system has been superseded by government bureaucrats, insurance companies, and hospital corporations. The enduring fiction regarding all of this is that these arrangements are simply evolutionary inevitabilities, and that all concerned just want to "do what is best for the patient." The reality is that everyone wants to do what is good enough for the patient consistent with the prior interests of those who throw around billions of dollars. That the AMA allowed this to occur in return for a few pieces of silver and cynical praise from political opportunists tells you most everything you need to know about what has happened to the AMA. There is a reason why AMA membership is dwindling, and it is not merely that an increasing number of physicians disagree with its positions. Like AARP, NAACP, Amnesty International, the Sierra Club, and the American Bar Association, the AMA has come free of its moorings and drifted away from the purposes of its founding, and been comandeered by the ideological vanity of its blinkered mandarins.

There is a unifying phenomenon underlying the rot of once useful institutions, and that is that there are some political issues that are too important for principles. Airy and unrealistic ideals seduce officials away from real solutions to difficult problems by appealing to the arrogance and conceit that are the noserings of the petty functionary.

The AMA allowed itself to develop interests apart from those of its members, and as a result betrayed one and forfeited the other. The AMA took its reputation as an effective advocacy group too seriously and ended up being conned out of it by low grade political grifters.

But there is something more at work here, and anyone who is curous about he future of healthcare should notice it. The role of patients and physicians is changing, possibly to the detriment of both.

In days gone by, a patient sought the services of a physcian, who provided them in an arrangement confined to those two parties. The system consisted of the doctor and his or her patients. From a system perspective, it was reasonable to think of “the doctor’s patients,” and direct system improvements to this local level. Then insurance companies and HMOs started manipulating provider panels, and constructing their own networks, leaving patients to confront the possibility that their doctor of choice would be dropped from the network. The model thus became one in which these were no longer the doctor’s patients, but the insurance company’s patients that the doctor was paid to care for. This model has lasted about thirty years, and during this time, the authority of physicians and their organizations have waned in influence. The next wave is now breaking. Hospital groups like HCA, and Banner Health are taking over physician groups, employing physicians in convoluted arrangements, so that now the model views “healthcare consumers” as the hospital’s patients that doctors are expected to treat with allegiance to their employers. Physicians have now slipped another rung, and the primary place that they once held in the healthcare system has been superseded by government bureaucrats, insurance companies, and hospital corporations.

The enduring fiction regarding all of this is that these arrangements are simply evolutionary inevitabilities, and that all concerned just want to “do what is best for the patient.” The reality is that everyone wants to do what is good enough for the patient consistent with the prior interests of those who throw around billions of dollars. That the AMA allowed this to occur in return for a few pieces of silver and cynical praise from political opportunists tells you most everything you need to know about what has happened to the AMA.

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