The Beast Speaks

The injured or ill move from the old intimate physician-patient relationship into the blood and sand arena of high tech public policy driven medicine. This transition is uncomfortable, to say the least, yet so far seems unavoidable.

Where public policy and administration of medical care is concerned, what we see now are problems that threaten failure of our entire medical system.

Recent heated debate, both in these pages and the public press, about cost-shifting and competition for dollars among providers of medical care, reflect our societal dismay (or dis-ease).

The SSVMS Editorial Committee has solidly reaffirmed a commitment to open and frank expression of opinion as essential to a rational progress in these unprecedented circumstances.

The voice of any individual physician should be as welcome to this debate, as that of any American. To reach a reasoned conclusion, I think it essential to be tolerant of views that vary from our own.

I have practiced in California for more than 50 years, the last 25 in emergency medicine, and have witnessed the birth of multiple generations of laws redefining the practice of medicine, as well as the coming of age of technology allowing people great control over their own medical condition. For me, as a physician, it has been a truly magnificent ride, not that I haven't made mistakes, but that I have learned to learn.

This is a time to speak clearly with one another, and with our fellow Californians, with a decent humility and respect - to listen tolerantly, unafraid of hearing that which we don't like. To learn that our once cozy profession has expanded exponentially to include a well-intentioned but myopic, bumbling Legislature, creators of the medical Frankenstein that now lays waste to medical practice; and that a public that once believed that magic was medicine now believes that medicine is magic.

The recent vigorous debate about a $2800 charge for re-evaluation and treatment of a minor viral illness is a case in point, defended by those chained to the millstone of mandated cost-shifting, and attacked by victims of

Robin Hood laws. Such practices constitute a stealth tax, raising insurance costs for all. Every day in Sacramento there are many more egregious similar incidents. They simply cannot be justified.

The real question is how to change laws that are unfair and unworkable, forcing hospital "providers" to charge Mr. A $10.00 and Ms. B $100.00, while a similar procedure in a private office is fraudulent if either A or B is charged more than $1.00.

Res ipsa loquitor. The beast speaks for itself.

lufboro@jps.net