What we need Washington to do

All we need is for our government to enact legislation that levels the playing field and allows small and independent practitioners--primarily primary care/ambulatory care--to compete in a free market entrepeneurial environment without the fear of being smashed like a bug by the huge corporate giants (HMOs). Small, efficient, independent practices can provide the majority of medical care in a community with much less overhead and expense than the huge HMOs. They can also negotiate directly with the patient for payment and with employers. Hospitals and HMOs should be concerned with less than 10% of health care that requires high cost, high-tech care. The specialists can be employed by them, if they so wish, but the primary care physicians should be independent!

Of course, this can not be done without real tort reform and other legislative changes--and without paradigm shift in our collective thinking as physicians. We must get out of the mode of fixing a broken system when we are part of the broken system. We need to think like businessmen/women AND as physicians. Otherwise we are slaves to the corporations that employ us and control us.

How can this occur? 1. Real tort reform with punishment for frivolous law suits and "lose you pay" changes. Caps on damages with payments amortized over calculated lifetimes, just like they do lottery winnings,and limits on contingincey fees for attorneys. 2. Loan repayment, tax credits, and interest free or low interest guaranteed loans for physicians--especially primary care-- to open private practices. 3. Legislation making it unlawful for the big HMOS and other carriers in the state to exclude all willing providers. 4. At least in our state, repeal of the gross receipt tax on medical care.

It is ironic that my small fee-for-service practice has to pay 7% gross receipts tax, yet the insurance companies are exempt! This can be done! I have done it and have been successful in a state that is not particulary doctor friendly with only 3 major players offering coverage and two of them are HMOs--and without any of the reforms that I have listed that would allow small independent practices to thrive and flourish. We need to take back our profession and control what we sacrificed the majority of our lives to attain.