Last week marked a
meaningful step towards improved heath care access for hundreds of
thousands of medically underserved Californians. SB 726 (Ashburn),
which would allow public hospitals in rural and medically underserved
communities hire a limited number of doctors passed on the Assembly
Floor by a nearly two-to-one majority.
This is especially satisfying because the California Medical
Association (CMA), a tour de force when it comes to political
influence, has become a formidable foe to the growing number of
Californians on Medi-Cal.
CMA quantifies the number of the States
doctors willing to treat Medi-Cal to be 30% – that’s 30% of 128,000, or
38,400, for 6.5 million, soon to be an estimated 9.0 million as a
result of Health Care Reform. While one can respect a private practice
doctors right to choose who he or she will treat; it is hard to
understand why CMA would be against legislation that would support
doctors willing to practice in communities where Medi-Cal and uninsured
are the majority of a community’s population.
Who is CMA? With a membership of 35,000, CMA represents ~ 27% of the
states’ licensed doctors. The organization has a history of political
activism and their in-house lobbyists along with several contract
lobbying firms are frantically working to kill three bills including SB
726 (Ashburn) that would allow public hospitals in rural and medically
underserved urban communities – many of which are part of California’s
Healthcare Districts – to hire desperately needed doctors.
These bills would ease the doctor shortages that are plaguing lower
income communities throughout the state. The bills would give doctors
who chose to treat lower income patients a stable income, benefits and
work conditions – thereby lifting the economic deterrent that keeps
doctors form working in rural and lower income urban areas.
While CMA cites various reasons for opposing these bills: potential
administrative interference in medical decisions when, in fact, such an
action is punishable as a felony; the disruption of the doctor-patient
relationship, should doctors make economic choices rather than clinical
choices; or when questioned by a Member of the Assembly Health
Committee on the basis for their opposition, a response of "It’s
complicated." Truth be told, the basis for the opposition’s position
is plain and simple: protection of profits.
Let me give you a real life example. There is a small rural hospital
in California that had one general surgeon. That doctor was receiving
a monthly stipend for providing call coverage for surgical cases
presenting the Emergency Room. He decided he wanted a raise to $2500
day ($912,500 annually) and the hospital said "no".
This surgeon quit
doing cases and forced the closure of the operating room, resulting in
the hospital laying off surgery personnel and forcing community members
to travel out of town for surgery. I know of many general surgeons who
would be thrilled to work for a third of that $912,500. Stipends for
covering the Emergency Room have been the biggest growth segment in
medicine in the last ten years. My estimate on the annual total cost
to California hospitals is in excess of $100,000,000.
By keeping California out of the national market for doctors seeking
employment options outside of Kaiser and other major for-profit Medical
Groups, and with the state’s medical schools neither growing in numbers
or students, the number of physicians in California has remained stable
over the past several years. Said another way, the supply side is
fixed. Like it or not, health care in California has been a commodity
for 25 years and as with any commodity, if you can control the supply
you can control the money.
California’s Healthcare District facilities are government entities.
They are owned by District taxpayers and governed by a publicly-elected
Board. Any cash-on-hand at the end of a budget year goes to paying
down debt, facility improvement, and reserves. The primary mission of
these entities is to assure access to health care for the community.
California is one of only a handful of states that prevents hospitals
from directly hiring physicians. Forty-five states allow the practice
and there is not one example of the kind of mischief CMA warns against.
Regrettably, the Golden State is a follower rather than a leader when
it comes to providing access to health care for the working poor.
Next, the big challenge will be in the Senate where CMA is expected to
continue mounting their expensive, full-court- press to defeat these
bills.