When I started working in the health care field almost four decades ago, doctors ruled the roost. 

In fact, doctors had considerable clout, both in the decision-making process of health care delivery, in medical economics, and in politics where organized medicine was a powerful lobbying force.

For good or ill, doctors headed up health planning organizations, health plans, and a broad spectrum of health related public and private entities.  Much of the leadership and many insights they were able to devote to the business of health care were positive, but few doctors were trained in admin-istration, planning, evaluation, accounting, or economics, or political science for that matter.  So, from time to time, some of them made more or less of a botch of things.

Over the years I have worked for, and with, many excellent, open-minded and brilliant physicians. However, I have always been keenly aware that there was a deep and distinct barrier between doctors and others, and, in some ways like the military and the police, there was a “we” feeling among doctors which made it difficult for many to accept non-doctors as full and equal partners in the health care enterprise.  In particular, the physician-patient relationship was sacrosanct.

Much has changed.  In the first place, what was called “Unified Membership,” required a doctor to belong to the County Medical Association, State Medical Association and the AMA (all three) if  he or she wished to belong to any one of these.  When that went away and became “Voluntary Membership” a great many members were lost at each of the three levels, and with them went a great deal of doctors’ political power.

Then, with Utilization Review, Managed Care, and decades of Wall Street frenzies of mergers and acquisitions, gradually the decision-making power in many areas of health care delivery (and economics) shifted from the doctor to the insurance company executive and the health plan entrepreneur.

Insurance companies, drug manufacturers and hospital chains became bigger and more powerful, and hospital staffs became locked in power-struggles with hospital owners.

Many doctors became embroiled in life-or-death battles with paperwork, third party payers, professional liability, bureaucrats and bean-counters.  Fees were cut and professional liability insurance premiums became unaffordable.  Doctors were forced to hire clerks to handle the burdensome plethora of forms from hundreds of insurance companies, each with different payment schedules and exclusions and co-payments and requirements for prior approval and on and on.  Many doctors gave up the struggle and quit their practices in frustration.

I'm convinced that, if doctors were still in charge and able to call the shots as they once did, the health care system as it exists today could never have become as dysfunctional and insane.  Since the new health system decision-makers have come between doctors and their patients, health care has become more and more expensive, and less and less effective in meeting the needs of the American people.

Fortunately, increasing numbers of people and increasing numbers of doctors are becoming aware of the dysfunctional state of the health care system, and the root causes of the outrageously increasing costs of health care.  Many people, and that includes tens of thousands of doctors, and particularly many of today’s brilliant medical students, are advocating for a rational system of universal health insurance.

Increasingly, doctors are becoming aware that the vested interests of insurers and corporate health care entities are barriers which stand between them and their patients.  Increasingly doctors and patients alike are beginning to realize that effective health care reform must include a fair and efficient single-payer funding system. Many doctors now campaign, as we do, to bring about Medicare For All for the American people!

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