AOA Advocacy Conference
Posted 4/8/06
This weekend I attended an advocacy conference for the AOA (American Osteopathic Association), here in Nevada. Mostly, it was an interesting and motivating conference about how to approach legislators and lobby for public change. There is a lot of good the AOA does representing physicians and I enjoyed meeting the various people who attended the conference.
However, I must admit I was a bit disheartened by some of what the AOA, and we can assume their counterparts their at the AMA (American Medical Association), advocate for. I learned that the AOA is working to restrict the right of psychologists to prescribe medications, working to restrict the right of pharmacies to offer immunizations and monitor medications, working to restrict in store clinics offered by companies such as wal-mart, working to restrict the practice rights of RNs (nurses), and they, the AOA, were just shocked :), that Oklahoma optometrists can now perform surgeries which had previously been restricted to ophthalmologists. Of course, in the AOA's defense, some of these legislative battles are fought to defend our practice rights from the various groups that want to take them away.
However, it does appear to me that the AOA is fighting many non-defensive territorial wars of regulation, using government to sustain a monopoly against market forces, ironically, in the same way that MDs once used government to shut out Osteopaths. Recall it was Mark Twain who testified before the New York General Assembly:
"I don't know as I cared much about these osteopaths until I heard you were going to drive them out of the state, but since I heard that I haven's been able to sleep."
Good intentions aside, I don't see why an organization needs to spend so much effort tearing down other professional groups, stomping on entrepreneurs, restricting patient choice, and, at least in this sense, and in my opinion, becoming part of the problem, rather than the solution to health care in America. In an indirect sort of way it is almost lessening the value it subscribes its own members.
During these debates about immigration, it has often been claimed that illegal immigrants are 'taking American jobs'. I always counter that if you need government to protect your job, if your own skill, hard work, diligence, and talent do not intrinsically define your individual value in a position of employment, than you don't deserve the job in the first place. Similarly, if given the freedom to choose, doctors are hemorrhaging patients, then docs better, government permitting, shape up or ship out.
Another contradiction can be found in the AOA position on keeping the status quo regarding the medical socialism perpetrated on the people of the United States via Medicare and Medicaid. The AOA appears to believe the proper position is not to cut these programs, or reduce dependency on government, but rather to keep reimbursements 'high', so more people are served as doctors can afford to keep seeing these patients. Of course, this sounds quite laudable, but it doesn't address the root of the problem or ask the ever pertinent question: Why do doctors want government to control their salaries in the first place? Why place your livelihood at the whim of whatever political forces happen to hold office?
Again, why do we need government to prop up the value of our labor? Why can it not stand alone, self-evident in its merit? Or, what if it turns out that this government meddling is actually lowering reimbursements for certain procedures to below market prices? In fact, we learned that private insurance used to pay much higher prices for procedures than what government offered, but had recently fallen to mirror the government mandates. Interestingly, an analysis of key differences between the procedures covered by private insurance and those covered by government programs appear clustered around preventative care and screenings, much of which only private plans cover. Why is this? It turns out improving the health of the patient also saves money for the private insurance companies. With government programs, these feedback loops are absent. One would think this would sink home most in the Osteopathic profession, which does have an emphasis on preventative medicine and whole body care, especially those practicing OMM.
The truth is that government cannot know, despite its best efforts, what certain procedures are worth to patients to receive, or doctors to perform. The value of your skill as a physician should, in my opinion, be set by your patients and the market, and thus reflect the pride in your individual ability.
But, returning to the contradiction, the AOA advocating increasing these government payments in the name of 'increasing patient access', does not seem to match with their rhetoric on these so-called 'in store clinics'. 'In stores clinics' are sort of 'fast food' doctors' offices set up in stores like Wal-Mart or Target. 'Increasing access' is exactly what they do. They perform quick lab tests, physicals, immunizations, and can prescribe certain medications. Occasionally they are staffed by physicians, but mostly by RNs, PAs, or some other combination of health care worker. These clinics provide fast, cheap care, targeted especially at the poorest Americans and those without health insurance. In fact, family members of more than one classmate of mine have used these clinics with great acclaim and upon occasion, great necessity.
The AOA is against these clinics, or at least wants to make sure only physicians can operate them and, at minimum, favors increasing the regulatory burden upon them.
Collectively, my impression of all of this is that it appears the interchangeable arguments of 'access', 'quality', and 'public safety' are empty shells, representing whatever is politically feasible to sell the goal of turf protection to politicians and the public. But then again, how can this be surprising to readers of this site? We've seen this sort of pattern play out in every special interest group from Social Workers to Manicurists to Public School Teachers.
Posted 7/27/06 (By Travis)
The Rise of the Walk-in Clinic
7/2/506 Newsweek A look at a new explosive phenomena that is sweeping the nation. These medical clinics are providing affordable, convenient access to healthcare. Previously, in 'AOA Advocacy' (4/8/06) I described the reaction of the medical community, which was, rather predictably, hostile. But, special interests need to provide cover for corrupt politicians to use the power of government to shut down upstart competitors and retain monopolies. 'Public Safety' is typically the slogan of choice used in the licensing/regulatory wars of the healthcare industry:
A report issued by the American Medical Association in June expressed concerns about the impact that clinics would have on physicians' practices and on patient care.
Dr. Larry Fields, president of the American Academy of Family Physicians, says his group's members have also been able to weather the competition, so far though some have adapted their practices to accommodate more patients. Last month, the AAFP issued a list of "desired attributes" for retail clinic practices, recommending the use of referrals for more serious cases, electronic medical records (which can be transmitted to the patient's primary provider) and a clearly defined—and limited—scope of services. "To the credit of many of these clinics, they've endorsed the guidelines," says Fields.
Still, he worries that the walk-in clinics may be tempted to expand the range of their services as they grow. "They may want a bigger piece of the market and that's a concern," he says. "In today's complex world of healthcare, patients really need to have a medical home."
Patients need to be left to make their own choices free from coercion and condescension from Doctor organizations.
See also 'Medical Lobbying'
See also 'DO Day on the Hill'
See also 'FDA Tyranny'
See also 'Government Health'
See also 'British Healthcare'
See also 'Canadian Healthcare'