Greater Louisville Medical Society

President’s eVoice

April 3, 2008

What do you think would happen if the gas and electric company decided to raise rates to maximize profits for their executives and investors? What if that strategy resulted in 17 percent of the citizens not being able to afford gas/electric service or not being able to buy it because the company didn’t like how much gas and electricity you used?

How about if some people got special rates based on where they worked? What if you lost water, gas and electric service to your house if you quit your job? Except for the most hardcore libertarians or social Darwinists, I suspect the public and political response would be swift and definitive: there is something wrong about this.

Since the early 20th century, certain essential services such as power, water, waste management, transportation and communication have been considered “public utilities” that need to be governed and regulated for the good of the entire community. Some utilities are owned privately, some publicly. Utilities are governed by Public Service Commissions that regulate the rates and services of the utility and resolve disputes that arise.

Most of us are not happy when we open our gas/electric or water bill, but are generally satisfied that there isn’t overt profiteering. We generally agree that planning for future growth and development of necessary services should be based on the public good rather than just free-market economics. It is also reassuring that there is an arbiter to resolve disputes.

In this political season I cringe every time a pundit makes reference to health care reform proposals as “socialized medicine.” Do you fear “socialized gas and electric?” Although there are strong advocates for a single-party payer system, none of the major presidential candidates or political parties advocates this solution. However, any physician who has experienced the changes in health care delivery systems over the past generation has to have serious doubts about free-market solutions to the problem.

Some might argue that we already have some regulatory groups, e.g. FDA, licensure boards, state department of insurance, grievance and appeals procedures. A number of consumer and physician-led class action suits against insurance company practices have been successful, but these have required a great deal of time and effort. The “game” needs a referee to call “FOUL!” in real time.

Legislative attempts at regulation and reform have not been successful at either addressing the problem of the uninsured or containing costs. As we have seen in Kentucky, many insurers have simply moved out rather than comply with the new laws. There needs to be greater uniformity of rules and regulations, a national “level playing field.” For example, reforms such as guaranteed issue (the right to buy insurance, restriction of practice of re-underwriting by insurance companies) and benefits mandates (e.g., mental health coverage) can only be successfully implemented on a national level.

If we begin to consider health care as a public utility rather than a free market commodity or “industry,” we can move toward regulatory reforms that address the problems of the uninsured and the spiraling costs of medical care. We retain the benefits of private ownership and free market competition and innovation, as we see in the energy and other utility companies. At the same time, we acknowledge that access to affordable health care is a right of citizenship rather than a luxury item.

Sincerely,

G. Randolph Schrodt, Jr., MD

GLMS President

About Us

The Greater Louisville Medical Society is committed to helping doctors help patients.

GLMS Mission

– Promote the science, art and profession of medicine

– Protect the integrity of the physician-patient relationship

– Advocate for the health and well-being of the community

– Unite physicians to achieve these ends