How to put American medicine in government hands

Commentary. By Susan Hershberg Adelman, MD, AMNews contributor. Sept. 23/30, 2002.

If I wanted to pave the way for a government takeover of American medicine, here is what I would do:

Increase the number of medical schools and develop health maintenance organizations, so doctors will be driven to compete with each other. Develop a resource-based relative value scale, so that specialists and generalists would squabble among themselves over their comparative payments.

Attack the good intentions, quality of care and stature of all doctors. Make the case in the media that nurses can deliver comparable care and are cheaper. Have lawyers argue repeatedly in courtrooms and in public that only lawsuits will prevent poor-quality doctors from harming hapless patients.

Then I would go after the American Medical Association. Doctors will look in their frustration to the AMA to fix all this, and I certainly would not want it to be effective. I would want specialty societies to grow larger and more important, forcing the AMA to compete with them for membership dues, for the right to represent physicians and for the claim to embody medical science.

After that, I would balkanize the AMA, dividing various groups of doctors to work against themselves. Start with setting proponents of science and ethics against proponents of hardball negotiating with employers and payers.

Push specialty societies to go after geographic societies. Incite a series of internal political disputes. Have an endless series of restructuring proposals paralyze the ability of the AMA to concentrate on its mission or to mount an immediate, massive membership campaign. [...]