Doctors And Monopoly Capital

Health care providers need to get organized. They need to do so pretty soon because changes in health care are coming in the near future.

If you do not believe Wonks Anonymous then you could check out Uwe Reinhardt's contributions to the Economix blog at the Times. If you don't believe Professor Reinhardt you might check out the relentless propaganda for medical cost cutting at Health Policy and Marketplace which would be the quasi official mouthpiece for the health insurance industry.  If you don't believe that then look at the President's budget which:
begins paying for investments that would eventually allow Medicare officials to refuse to pay for medical treatment that does not show evidence of improving health. If successful, that change would vastly reduce the government’s long-term budget deficit. It is also likely to bring down private health costs, since insurers typically follow Medicare’s lead.
From a story by David Leonhardt.

And, in Wonks Anonymous humble opinion, this is not necessarily a bad thing. Too much of our medical practice in the US is run as a cottage industry. Doctors and small medical groups too often provide uncoordinated care with many doctors seeing the same individual.

Many doctors make heroic efforts to try to organize and orchestrate the care of their patients and Wonks Anonymous does not question their good will and extreme dedication. Nevertheless he feels that modern medicine is simply too big and too complex to be managed by individuals. We produce our cars and airplanes in large, integrated production facilities. We need to produce health in the same way.

And we will do so eventually, The real question here is who will be in charge of producing health care. If doctors and other health care providers don't get organized the people who control health care will likely be the people who control the stream of payments that the public makes for health care. That would be health insurance companies and the government.

Doctors and hospitals could still work within their old organizations and structures but their choices would increasingly come under the scrutiny of insurance companies and government agencies. They would be managed by these agencies just as surely as many "independent" chicken and hog farmers are managed by the meat packing companies that buy their product.

And the new managers would have neither the incentives nor the skills and knowledge to provide good quality care to the public. The insurance companies would be beholden to their stockholders and seek the cheapest possible care provided that it did not inspire public outrage. Government functionaries would keep the public more in mind but would still be driven by the need to meet budgets and cut costs. Although some small number of doctors might work in these management structures most decisions would be driven by people trained in business and accounting and motivated solely by financial considerations.

There is a better way and Doctor Sydney Garfield found it in the 1930's. Doctors can work together with hospitals and financial experts to provide prepaid medical care. Doctors can form a producers cooperative and, if they maintain control over this cooperative, they can control enough cash and other resources to control their own production process.

And we can see the results of this form of organization. Wonks Anonymous would suggest that, for all its problems and it has many, Kaiser Permanente has been able to maintain high standards of quality in its care, high levels of public service and reasonable efficiency and control over costs.

Where insurance based HMOs have become sorry devices for extracting unpaid labor from contracted doctors and hospitals on the one hand and for restricting patient access to necessary care on the other, Kaiser has maintained a good reputation for quality care. The difference here is that the care decisions Kaiser are made mainly by the Medical group where doctors supervise doctors and not by managers at insurance companies who may have only rudimentary knowledge of medicine.

This route to organization is still open, right now. Many doctors already work in large medical groups and these medical groups are often affiliated with non-profit hospital organizations. For example, doctors affiliated with Sutter Health Hospitals in Northern California might want to incorporate with Sutter Health to provide integrated, prepaid medical care. They might find that, as they worked together, their ability to deliver quality health care at lower costs had improved.

They would certainly find that they had greater clout when bargaining with the insurance companies and the government.

Besides Kaiser needs the competition to keep it honest.


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