Snookered Again

Published September 1, 2001

Most physicians are wonderful people. They are super intelligent, ethical, and brave. They take upon themselves the burden of deciding matters of life and death. And not just in some abstract, theoretical way, but down and dirty where the blood is.

They put themselves directly on the line every day. When they fail, they personally have to look the grieving family members in the eye, and report, “I did all I could, but it wasn’t good enough.” Now that is courage of a kind very few of us will ever know.

But when it comes to business or finance or politics, physicians can be idiots. Because doctors are smart and courageous, they think they can handle anything. They think if they just apply their keen powers of observation to any given situation, they will prevail. This is what they thought when managed care came around.

As much as they currently complain, physicians brought managed care on themselves. They gladly signed the contracts that made managed care possible. In some cases, they actually invested in the managed care organizations (MCOs), never realizing that owning the organization did not mean they would control it. Control was ceded to managers who soon pushed the doctors to the periphery.

Why did they do it? They thought they were smarter than the accountants, bookkeepers, and actuaries. They never thought they would lose control. Plus, each doctor thought his or her own work was so special, so important, so sensitive to the needs of patients, that it would never be questioned. Oh, sure, the MCO might restrict that other guy around the corner, but me? No way. Why bother reading the fine print?

It was a painful lesson to discover they had been snookered, that the managed care managers didn’t think there was anything special about Doctor X. He soon learned he had better toe the line just like all the other doctors. Besides, he had signed a contract. What choice did he have?

Unfortunately, most physicians still haven’t learned the real lesson. And today they are being snookered again, this time by the trial lawyers. The trial lawyers have told the docs that the Patients’ Bill of Rights will bring down managed care . . . that it will restore the doctor/patient relationship and return them to the driver’s seat.

Failing to Read the Fine Print

The American Medical Association (AMA) came out all gushy over the Ganske version of the Patients’ Bill of Rights in the House. But it is doubtful any of the AMA officials have actually read the bill. If they had, they wouldn’t be so enthusiastic.

In fact, the Ganske bill will not end managed care. What it is likely to do is end traditional fee-for-service health insurance and make HMOs run even tighter managed care programs than they have before.

Why? Because a health plan will be liable for up to $5 million in punitive damages if a patient is “injured” by the plan’s “failure to exercise ordinary care” in making decisions. That means health plans will be extremely careful in making decisions. They will take far more than “ordinary care.” In fact they will take “extraordinary care” to make sure everything possible is done to avoid harm to a patient.

The Institute of Medicine’s recent report, “To Err Is Human,” alleged as many 98,000 “preventable” deaths, and uncountable injuries, are caused by medical practitioners every year. At a time when harm comes that easily, health plans are likely to engage in an unprecedented level of micromanagement of physician behavior to avoid any suggestion the plan was responsible for any injuries.

And all of it will need to be documented in writing as a defense against possible lawsuits. Physicians will not be able to scratch their noses without writing it down and reporting it to the plan.

More Bad News for Doctors

Rather than restoring physician autonomy in dealing with patients, the Ganske bill specifically forbids autonomy. The language states quite clearly, “there shall be no deference given to . . . the recommendation of a treating health care professional” when an “External Review Entity” makes a coverage decision. Coverage decisions will be made by a body that never examines the patient, never talks to family members, and has no knowledge of the particular situation involved other than the written record.

So, once again the AMA and physicians in general have been snookered. They failed to read the fine print and are supporting something that will do just the opposite of what they thought it would do.

Greg Scandlen is a senior fellow in health policy for the National Center for Policy Analysis and contributing editor for Health Care News. His email address is [email protected].