A Threat to Health Care

During my half-century in medical practice, I have had the opportunity to observe, with ever deepening remorse, the status erosion from "honorable physician" to "medical provider," from "noble professional" to "vendor."

Primarily responsible is medicine's conversion from a profession to a business, where the laws of capitalism apply, with its emphasis upon efficiency over morality. Lacking morality, the practice of medicine, as a profession, continues losing its integrity.

Contributing factors include the absence of physician training in compromise, making them poor competitors for contracted business professionals hired to reduce medical care costs. Equally important are the antitrust laws, which rob physicians of organizational bargaining power to fight for and protect "medical rights."

Physicians' virtue of independence makes them loath to embrace "medical political action committees" to influence legislation such as ERISA (the Employee Retirement Income Security Act), used as a basis for the recent Supreme Court action favoring HMOs.

Loudoun's affluent baby boomer population, about to take center stage, will markedly increase the need for medications, hospitalizations, rehabilitation and nursing home services, making its medical monetary stakes enormous.

The interplay of these factors has pitted the "Wal-Mart" of medicine against a tiny nonprofit community hospital in a classic David and Goliath rerun. Amassing more than 267 hospitals in less than six years, the Goliath eventually paid the piper, Medicare, more than $700 million in medical fraud charges.

Its arrogant financial prowess again erupted when it attempted to purchase 40 percent of the nonprofit insurer Blue Cross of Ohio, where upwards of $9 million was awarded to board members willing to sign the contract.

The "creme de la creme," however, came when it helped get the brother of its founder elected to the Senate leadership, virtually guaranteeing influential input into the medical decision-making process at the highest government level, no doubt responsible for the recent about-face of Virginia's state health commissioner, granting it permission to built in Broadlands.

Its modus operandi is well documented: Purchase the predominance of successful medical practices using inflated contracts to capture the area's ambulatory care delivery system, underbid all competitors for hospital admission rates to capture inpatient care, relegate the indigent to competing hospitals, forcing them into default, then making them an offer they cannot refuse -- all in a gesture of goodwill, of course.

Contract physicians, their patients now a possession of the new facility, face salary cuts, and uncooperative independent practicing physician's privileges face termination, all in the name of efficiency.

Once dominating Loudoun's health care system, this Goliath will demand ever-increasing reimbursement from insurers in all areas of patient care to improve stockholder equity.

The insurers, to remain financially viable, will raise health care premiums for everyone in Loudoun. In approving the new hospital, the board would, in effect, be down-zoning medical care in Loudoun with the same disastrous results upon the medically needy, in making insurance unaffordable, as was done by the previous board upon the housing needy, in making housing unaffordable, when it down-zoned the land.

Lawrence V. Phillips

Round Hill