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Blame Poor Care On Big Business

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By DENNIS AGLIANO

Published: December 30, 2007

Ms. Goudreau, your comments were sad but unfortunately true.

It is not by accident that the kind of medicine you yearn for from 25 years ago, where the doctor-patient relationship was the way Americans want it to be, has changed.

The reason is obvious. Control of medicine is largely in the hands of big business - insurers, hospital chains, pharmaceutical companies and nursing home conglomerates - instead of the patient and his/her physician, as it once was. We, the American public, were duped by groups in the pre-Clinton and Clinton years, into believing that medicine was too expensive, at about 13 percent of GNP.

With the advent of managed care, the initial savings was achieved by lowering physicians' fees, which continues even now. Twenty-five years ago, the physicians' part of the health care dollar was slightly under 20 percent. It is now about 8 percent, while the costs of doing business have escalated.

We are now at a point where 20 percent or more of health care premiums go to administer managed care for the profits it reaps - dead dollars that do nothing to improve patient care. The ultimate sting is that the costs of this corporation-controlled medicine are now above the 13 percent of GNP that it was intended to lower.

So now let's answer why this new specialty you mention in your column - the hospitalist - has evolved. You are correct that this specialty group has helped doctors, hospitals and insurance companies find efficiencies - while it has not helped the doctor-patient relationship.

Be mindful that under the current system of corporate control and shareholder profits, primary-care doctors are unable to pay their bills if they don't spend more time in the office seeing patients. Going to the hospital, for the paltry amount that managed care pays the physician, is too costly, even though he or she would like to do so.

The big losers are doctors and their patients.

Now, instead of going back to a system that worked so much better 25 years ago, we have some presidential candidates espousing a universal health care system. On the surface this may sound good, but it will ultimately put another barrier between the patient and his or her doctor.

There is an answer. It's what makes America great. It's the free market place. But for some reason, our politicos want to deal with medicine differently. Perhaps, we should socialize every business and every profession.

DENNIS S. AGLIANO, M.D.

Tampa

The writer is a past president of the Florida Medical Association

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