By the time I graduated from medical school in 1987, it was becoming clear that the rising prices of health care could not be met by the payment system then in place. So insurance companies, physicians, consumer and business organizations, and government officials all began exploring ways to limit medical costs and change reimbursement. Like a patient with seizures, American medicine convulsed into a hodgepodge of delivery systems that bore little resemblance to the American medicine my father knew. HMOs and PPOs entered the medical lexicon. How we got to this situation is a subject of great debate.
Insurance companies argue that too many tests are ordered and too many procedures are performed.
Patients argue that hospitals and doctors charge too much and insurance companies pay too little. Government officials argue that doctors, insurance companies and hospitals are protecting their own turf and are in need of new regulation. Last fall, the American Medical Association created a labor organization called Physicians for Responsible Negotiations. Next year, the PRN expects to move large groups of physicians through the organizing process and become their bargaining agent, too. Luckily for sick patients and the Hippocratic Oath, this embryonic union movement has ruled out strikes.