Editorial: Docs vote to create a union

Sunday, June 27, 1999 | 9:20 a.m.

In a way it probably should not come as a surprise that doctors, who chafe at the bit of the HMOs, would seek to regain more control over patient care. Still, it was remarkable when the American Medical Association voted Wednesday to create a national labor union for doctors in an effort to get back the autonomy that has been eroded over the years by health insurers.

The AMA traditionally has been viewed as a conservative organization, not one to rock the boat. But the HMOs finally pushed too far in their zeal to maximize profits at the expense of patients. This is a significant development in the movement toward better patient care, but it also needs to be understood that the unionization plan passed by the AMA is not radical by any means.

Most importantly the AMA vowed that doctors -- unlike other members of unions -- would not strike, which could endanger patient care. Through collective bargaining, the AMA believes, doctors could challenge health insurers' abusive and unfair practices. "Our objective here is to give America's physicians the leverage they now lack to guarantee that patient care is not compromised or neglected for the sake of profits," Dr. Randolph Smoak, chairman of the American Medical Association, said.

Doctors who are full-time employees of HMOs or hospitals already can unionize -- it's been estimated that between 38,000 and 45,000 doctors are members of unions. The AMA's decision simply means that it, too, will join this effort to organize doctors. Self-employed physicians are barred under federal antitrust laws, however, from joining a union. Legislation is pending in Congress that would allow these independent physicians to collectively bargain with insurers, a bill that the AMA also supported Wednesday.

The health insurance lobby immediately denounced the AMA's actions, saying they could result in higher costs for consumers. Unfortunately this is the industry's worn-out response to any HMO reform that is proposed. The bottom line is that HMOs brought this on themselves by their slavish devotion to profit-making.

One of the ironies in all of this is that if Congress in 1998 had passed a patient's bill of rights, the push for unionization by the AMA probably would not have materialized. But the powerful HMO lobby persuaded the GOP leadership in both the House and Senate to kill this legislation last year. There is a push once more for a patient's bill of rights, but it is running into the same opposition this year.

When managed care was initiated there indeed was a need to get spiraling medical costs under control. What has steadily happened over time, though, is that patient care has suffered as the HMO bean counters exert more power over what services doctors can provide. Congress should finally stand up to the HMOs and level the playing field, creating a patient's bill of rights and passing legislation that would allow independent doctors to join a union.