A few days ago, I watched two talking head guests discuss health care reform with a TV personality (hardly a journalist). Both guests were physicians. One had a pony tail and practiced in a small rural clinic. The other was a distinguished-looking gentleman who was a past president of the American Medical Association. The ex-AMA president said he was opposed to the proposed health care reforms because he dreaded governmental control. He hissed "governmental control" as if it were a pygmy rattlesnake.
What amazed me was that he made this statement while maintaining a Jack Benny straight face. You have to admire some one who can do that. This physician owes his whole professional life to governmental control. Governmental control gives him the license that permits him to charge for his services. Governmental control prohibits all others from the practice of medicine. Governmental control gives him exclusive prescription privileges. Governmental control means patients must visit his office and pay a fee to get a prescription. Governmental control means that all mid-level providers must practice under the supervision of a physician. Governmental control means that by affixing his signature to a piece of paper he can generate revenue for his practice.
This kind of governmental control did not always exist. Just over a century ago, the typical doctor probably had less medical training than a nurse technician does today. Medical school consisted of about three months training. Really.
Hordes of people hung up a shingle. Not surprisingly, the profession didn't pay all that well. So with governmental control, physicians decided to raise educational standards and limit the number of student slots in medical schools.
Medical care did improve; however, this policy drastically limited the number of persons who could earn a medical license. This manipulation of the supply of physicians resulted in larger professional incomes for practitioners. Governmental control increased medical costs for patients. This was acceptable because by this time our culture was accepting the idea that health care should be a commercial, wealth-producing enterprise.
Currently, governmental control means that well-trained, foreign physicians find it difficult to get a license to practice in Florida. In fact, reciprocity for a medical license does not exist among the 50 states. This partly explains why per capita costs for Medicare patients in Miami runs about $17,000 per year and the cost in Denver is about $6,000.
The other factor is that Medicare reimburses for medical services using a formula based on prevailing local rates. If all physicians in a locality decide that their fee for an office visit should be $125, Medicare takes that local prevailing rate into consideration when setting reimbursement rates. This reimbursement policy is the result of lobbying by the health care industry.
Governmental control does not have to work this way. State laws that physicians lobbied to enact could be amended so that nurse practitioners are granted liberal prescription privileges. Michigan nurse practitioners have liberal prescription privileges.
When my late wife, a nurse practitioner, moved to Virginia, she lost the prescription privileges she had in Michigan. Virginia does have liberal prescription privileges for nurse practitioners practicing in rural settings but essentially no similar privileges exist in urban areas — as if where a patient lives has anything to do with who is qualified to prescribe medicine. This policy uses governmental control to enhance income for physicians at the expense of the patient and exclusion of other health care providers.
Governmental control doesn't have to work this way. In France, physicians who seek government reimbursement do not set fees for procedures. There is a national committee that evaluates the required skill and time involved for each procedure and sets the appropriate reimbursement fee. In Brazil, pharmacists can prescribe. The patient is free to decide whether to consult a physician.
The point is: Medical policy in the United States is only tangentially determined by science. We accept that providing health care should be a moneymaking business. Current governmental control has been created through the lobbying efforts of the health care industry. Poor sick people are unable to pump millions of dollars into re-election campaign coffers. Their voices are unheard.
Yes, we do need government control. The AMA thrives on it. Increased governmental control in the early 1900s produced a massive improvement in medical services. Now, with our nation spending about 17 percent of GDP on health care, the time has come for improved governmental control to assure that all citizens have access to affordable health care.
Since all other developed nations have achieved universal health and actually spend about half of what we spend in the U.S., it is reasonable to assume that wasteful profiteering can be redirected to serving the needs of all citizens. Better governmental control will not result in bankrupting our economy; in fact, increased governmental control is the only way financial disaster can be prevented. Governmental control is needed to create a fairer balance between patient health care needs and profits for the health care industry.
C.D. Chamberlain of Spring Hill has served as a pastor, mental health administrator, lobbyist and editor.