Marching on the Capitol

A blow-by-blow, or at least step-by-step, account of the physician demonstration that was the centerpiece of the CMA Legislative Day.

The other was rather more violent. It happened at a base where I was assigned as a general medical officer. Several hundred Cambodian soldiers there were being trained to use American equipment with which to go back into their own forlorn country to fight the Khmer Rouge.

The Cambodians, who occupied a separate section of our camp, became enraged at the quality of their food. They tossed some grenades, trashed their mess hall and shot the chief cook. As I was the only doc on the base, I had to pronounce him dead to satisfy military protocol. He was dead all right. I reckoned his death occurred not long after the bullet hit him in the back of his head.

Now that was a real protest and demonstration! By the way, I think that the food did improve soon thereafter.

More recently I was fascinated, as I am sure you all were, by the demonstrations in Damascus after the death of Hafez Assad. People marched around the main public spaces in the city, many carrying large photos of the dead president and some with large photos of his anointed successor, his ophthalmologist son Bashar.

On television news, the photographic crews had filmed groups of sweaty young men, all clearly agitated and wailing more or less in unison. The reporter said they were chanting something like, "We will dedicate our hearts and our minds and our blood to Bashar!" That is a very difficult chant for hundreds of people to do at once, although maybe not in their own tongue.

But it is a lot tougher than what I shouted on April 26. The chant that I and a few hundred other docs used, as we strode en masse from the Convention Center to the north steps of the Capitol was, "Shame! Shame! Shame on California!"

The demonstration was the centerpiece of this year's California Medical Association Legislative day. It was designed to draw attention to California's dismally low ranking in Medicaid ("Medi-Cal") reimbursement rates among the 50 states.

We heard many speakers that day, and more than one pointed out that veterinarians receive more money to set a dog's broken leg than do orthopods for setting a child's broken arm.

And skepticism about our government's willingness to rectify this problem ran amok when the governor's plan to raise Medi-Cal rates was revealed. Overall, it would provide only a 17 percent higher reimbursement rate for MD services-still not enough, everyone agreed, to get us up to parity with our veterinary colleagues.

Many other disparities exist. For example, California ranks dead last in Medicaid managed care reimbursement rates. Adjusted for inflation, Medi-Cal rates have fallen 54 percent since 1985. Disinclination for physicians and health plans to accept Medi-Cal patients and disenchantment with the general state of publicly funded medicine and medical care in California grows apace among California physicians.

And so the idea for the Great Physician Demonstration of 2000 was born at CMA. It was frankly conceived to attract press and TV attention to our professional plight and to impress the Legislature and public that we are all truly concerned with the deterioration of the government-supported health care delivery system in California.

After a light breakfast and informative talks by CMA staff in one of the large meeting rooms at the Convention Center, we assembled in the ground floor foyer to pick up 2 x 3-foot brightly printed signs proclaiming, "SHAME ON CALIFORNIA."

Just outside the door at the southwest end of the Convention Center was an ambulance which, slowly and with lights flashing, led us down the sidewalk between the Convention Center Theater and the Hyatt Hotel, thence to L Street and right towards the Capitol.

Many of the docs had their clinic garb or lab coats on, several festooned with stethoscopes draped over their shoulders. Some carried homemade protest signs. As we walked along behind the ambulance, energetic CMA staffers armed with bullhorns encouraged chants in unison-"Shame! Shame! Shame on California!"-over and over again. It took a while to catch on, but enthusiasm rapidly grew and a mere murmur soon became a throaty roar, and we out-shouted the bullhorns.

The police had L Street blocked off, so we were able to walk down the street behind the ambulance unimpeded to the north steps of the Capitol, all the while chanting our ever more rhythmic slogan.

Lots of people stopped and stared and many asked who we were and why the lab coats and how come shame on California? The drivers of cars that had been stopped on L Street all looked uniformly upset and we probably lost a few friends there. But, hey, that is the price all demonstrators pay. You are sure to upset someone. Broken eggs and omelets, and all that.

Anyway, there we were, all us normally stodgy docs yelling our lungs out and assembled in front of the Capitol. We quieted down to listen to some speakers, among them CMA Executive VP Jack Lewin, CMA President Marie Kuffner and Joyce Hightower, President of the Golden State Medical Association.

Several legislators dropped by as well. The loudest applause and cheers came when Senator John Burton appeared and spoke to us. There was Senator Burton in his usual scruffy persona showering us with praise for our activism and promising us his support.

As he spoke, I was not alone in my contemplation of the vagaries of medical politics that had moved many in organized medicine away from a long friendship with relatively right-wing Republicans into a comfortable working relationship with liberal Democrats like Senator Burton.

The speeches over, we drifted as a disorganized but happy mob back over to the Convention Center for lunch. We all felt generally satisfied that we had done well, had made some joyful and politically pertinent noise, and just maybe had raised the consciousness of a few people inside the Capitol regarding our issues.

I felt happy and proud to have taken part. I even had a touch of laryngitis to prove I had screamed with the best of them. I did not see myself on television, nor was my picture in the newspaper, but Steve Polansky's was.

We reprint it here as it appeared in the San Jose Mercury News. He looks pretty good, I think. Perhaps he does not appear as dramatic as those sweaty glowering young men in Damascus, but he cuts a fine figure and is obviously enjoying his role as an official, bona fide protest march demonstrator.

It was a great day. My first march, my first demonstration. Quod erat demonstrandum, indeed.

John.Ostrich@kp.org