Somehow I missed this article and blogged on the wrong subject!
And now I've read the Ring article.
I was six years old when this article was written. For all that it says about the "new" AMA, there has been little done, I'd guess, about the problem of the uninsured or the underinsured as mentioned by Ring.
Ring asks: "Are we a profession to which business interest is incidental or are we a business to which our professionalism is incidental?" I think that the concept of sacrifice, altruism, and professional runs deeper in medicine, much deeper than the organized business aspect of it.
But given the huge opportunities for profit in organized medicine, it is no surprise to me at all that much of medicine, at least on an administrative level, has much to do with profits. If there is a situation where there is a profit to be made, there is somebody willing to work that situation to their benefit. A million anonymous shareholders to which a board is responsible? Tell them about sacrifice and altruism and see what happens. Do something unprofitable about the un- or underinsured? Probably not, I'd guess.
I have a good bit of my savings (a few thousand dollars) in a health care mutual fund. It's been doing really well.
I think that there must be changes in the healthcare system soon - there are too many access issues, at least from my own experiences in rural Pine County MN. And I'm guessing that many of these changes will come through political processes, not the AMA. And these changes will possibly (probably?) decrease the profitability different medical systems... so I'm going to be moving some of that money into other funds!
Drs. Hafferty and Nordehn, what do you think about this? I do not come from a medical family; my dad drives trains and my mom helps run a small store. So my experiences in medicine, especially on the business side of things, are limited.
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2 comments:
Your blog made me smile.
It is the only one that mentioned the stock market -- so I will just say (with a smile) -- "remember to diversify" (and let me know -- on the side) the name of your fund (wink, wink).
And while we are on the topic of business, you and I both know that the board has a fiduciary obligation to act on behalf of the owners (the shareholders) and to place their interests first -- and that this fiduciary obligation -- unlike medicine's --is legally mandated (they can go to jail for not fulfilling it).
So - we have one (type) of fiduciary relationship (medicine) versus another (business).
I suspect you are right about the political process. I'll be interested how close to center stage health care stays in the current presidential election. As unfortunate as this sounds, as long as access was a problem of the poor, it was ignored. I think we will see changes as un and under-insurance becomes more of a middle class problem. I know this has been said for a while, but we really cannot go on this way too much longer.
I enjoyed your comments. I have a comment on Dr. Hafferty's comment.
There is a fiduciary duty of the board to serve the stockholders well - or, they may go to jail.
But - what I see happening is this: the boards are obsessed with profits and not concerned enough with taking care of the patients. This results in very nice short term profits. However - - - my prediction is that this is not sustainable in the long run. In the long run the decisions of boards of health insurance companies will (and are about to) drive them out of business.
The boards by not insisting on maintaining more open doors for people to have insurance are leaving huge numbers of people uninsured. The uninsured still show up to the hospital. They cannot pay the bill. The hospital has to do something to pay for the uninsured. The hospital then increases charges to all of those who can pay. The insurance companies then pass this along to those with insurance. The only (my view here) player in this that is still 'making money' is the insurance company. The hospital (and clinic) is nearly going broke because of all of the bad debt. And, although not always obvious to those with insurance as it comes out of the pay check before people see it - - - the cost goes up and up and up. And . . . those with insurance are subsidizing those without. When we write grants - we add about 38% more for fringe benefits when we have faculty salary included on the grant - - - that 38% is almost entirely for health insurance.
I don't know - but presume - that if we spread the cost of insurance around to everyone (by having a one payer system run by the government), instead of only having it for those with positions at large organizations, that the increase in taxes would be less than 38%. (And remember, a good portion of our taxes also goes to pay for medicare and medicaid.)
The "bargain" tax rates most people perceive we get by not having nationalized health care in the US, when we compare ourselves to our European counterparts, is smoke and mirrors.
My forecast is that eventually the public will wake up - and - demand a less costly system. And, the end result will be that these insurance companies looking at short term profits will close their doors. And they will be closing their doors because their board of directors did not do their long term fiduciary duty: looking out for the long term survival of the company . . . by helping figure out how to better spread the cost of health care to all, rather than have an increased burden on those with insurance.
Disclaimer: I do realize most without insurance pay a lot for their health care. But - many without insurance put off preventative care and end up spending many more health care dollars than if they had been allowed to somehow have insurance. And, the number one cause of bankruptcy in the US is medical care dept - and this is not paid by those uninsured who are forced to lose every dime they have trying to avoid becoming bankrupt - it is paid by those with insurance.
The movement to attempt a change is afoot: Mass. passed their landmark law. It will be interesting to see what happens - if anything - after this election. Everyone is, as usual, promising everything.
Boards of directors of some huge banks were giving CEOs enormous bonuses. As the fed govt. bails out these banks (if this is possible) one of the first items of contention is whether the govt. can now regulate CEO salary bonuses.
(Stephen Wiggins, CEO, Oxford Health Plans, Inc. (An HMO) received a $29,061,599 salary in 1996. Source: http://www.harp.org/hmoexecs.htm) I cannot locate the CEO bonus at MN Blue Cross Blue Shield - but my recollection is that it was very high.
Not much "sacrifice, altruism" (to quote Cold) in a salary like that.
Colt, you comment that you believe much of the changes will come from the political process not the AMA. I agree - the AMA does not represent (through membership) a very large portion of the physicians in the country. Whereas, supposedly, the government does.
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