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Jewish World Review July 1, 1999 /17 Tamuz, 5759

Linda Chavez

Linda Chavez
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How to put doctors and patients back in control of medical-care decisions -- THE VOTE LAST WEEK by the 700,000-member American Medical Association to form a union ought to strike fear in the heart of every American. The last time a similar group of 'professionals' decided to form a union, they nearly wrecked their profession.

The National Education Association went down this path a generation ago, and American education has never been the same. What started out as a well-intentioned move to improve pay and working conditions for teachers dramatically altered public education for the worse. What followed was the politicization of education and a decline in education standards. Will the AMA's efforts fare better? Not likely, despite the assurances of the group's top leadership.

"This will not be a traditional labor union," promised AMA chairman Dr. Randolph D. Smoak Jr. "Your doctors will not strike or endanger patient care. We will follow the principles of medical ethics every step of the way." The NEA made similar promises in the early 1960s when it decided to adopt "professional negotiations," a thinly guised euphemism for collective bargaining, according to author Myron Lieberman ("The Teacher Unions," 1997). Like the AMA, the NEA initially opposed strikes. Instead of strikes, the NEA urged "professional sanctions" against school districts if they treated teachers badly.

The NEA sent teams to investigate and report on problems between teachers and school districts, which they then disseminated to their members and to teachers' colleges and employment agencies in the hopes such information would dissuade teachers from applying to work in the offending districts. By 1966, the NEA abandoned its anti-strike scruples when the Newark, N.J.,Teachers' Association struck the local school district, and in 1969 the NEA formally revoked anti-strike provisions in its governance rules.

Despite assurances to the contrary, AMA doctors will likely follow suit once their union gets off the ground. In the beginning, the AMA's bargaining will be restricted groups of doctors employed by hospitals and health maintenance organizations, since federal law currently prohibits doctors in private practice from unionizing. That could change, however, if Congress adopts new legislation proposed by Rep. Tom Campbell, R-Calif.

The impetus behind the AMA's move is widespread dissatisfaction among doctors with the way HMOs reimburse them and the restrictions HMOs place on patient care. Both doctors and patients blame HMOs and insurance companies from the restrictions they have placed on the delivery of these services, but the real villain is the 'third-party payer' system of health-care financing in the United States.

Unlike most other industries, health care does not operate in a free market, which would regulate prices through competition. Virtually no one in the United States pays directly for health care, and most Americans don't even pay directly for the insurance that covers their health care. Instead, most working Americans receive their insurance through their employers and often pay for only a fraction, if any, of the cost of that insurance.

Ironically, unions are largely responsible for this system, which came about through collective bargaining agreements that sought to provide non- taxable fringe benefits to union members during periods when higher wages were difficult to obtain. To complicate matters, health-care insurance soon began to cover not only the cost of catastrophic care for major illnesses but routine physicians' visits as well.

The major problem with the system is that neither patients nor doctors have incentive to control costs. Just imagine if a similar system existed to provide for the costs of some other necessity, say food or housing. What if every employee had 'insurance' paid for by his employer that covered the cost of groceries or paid for the rent or mortgage, with no limits on what the insurance bought? Would anyone buy hamburger when they could choose filet mignon or live in a 1,000 square-foot- house when they could pick a mansion instead? And how about the grocers and home builders --- wouldn't they raise prices with no fear that their customers would go elsewhere since a third party was footing the bill anyway?

If the AMA really wants to put doctors and patients back in control of medical-care decisions, it should look for some free-market solutions to health- care financing instead of unionizing its members.


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8/25/98: Only consistency about Prez's anti-terrorism policy: its inconsistency
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5/20/98: Sometimes Buba actually tells the truth ... as he sees it
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4/21/98: Legislating equality
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4/7/98: Mexican mayhem?
3/31/98: Of death and details
3/25/98: Americans are unaware of NATO expansion
3/18/98: Intellectual-ghettoes in the name of diversity
3/11/98: Be careful what you wish for ...
3/4/98: The Press' Learning-disability
2/25/98: 50 States Are Enough!
2/18/98: Casey at the Mat
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2/4/98: Faith and the movies
1/28/98: Clinton, Lewinsky, and Politics Vs. Principle
1/21/98: Movement on the Abortion Front
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12/17/97: Opening a window of opportunity (a way out of bilingual education for California's Hispanic kids)

©1999, Creators Syndicate