Medicine from the Factory Line : The trend toward maximizing profit by limiting patient access to doctors will get worse before it gets better.

Medicine at its best is one of society’s “sacred” occupations, demanding more of its practitioners than, say, factory work or politics. Doctors and other health care providers are expected to give personal time unstintingly, keep secrets and counsel individuals without thought of personal gain or comfort. Most do feel a responsibility to their patients that goes beyond personal aggrandizement.

But remote and recent events are quickly making the art of medicine a business. Though the Clinton health care proposal backfired on its creators and gave medicine a colossal shove into the arms of the for-profit folk, it did no more than accelerate a process set in motion more than five decades ago. It’s important to realize that most health care workers don’t benefit from the current entrepreneurialization of medicine. And we see terrible things coming. A wise physician once said people don’t give quality-of-health-care issues a thought until they’re sick. Unfortunately, when you’re sick, it’s hard to change aspects of your care that aren’t right. That was proved by the woman whose HMO refused to fund her potentially life-saving breast cancer therapy, claiming it was still experimental. Her side won in court. But she was already dead.

What is happening now is that in an effort to control cost, we have actually interjected a whole new administrative layer into medical care, one that has every intention of sucking up huge profits through brokering access to care. These “managed care” companies get richer when patients don’t use as many interventions, when fewer doctors are forced to see more patients in the same time.

The American public has been fed the line, repeated until it has burned into our brains, that there is a health care crisis and that it will bankrupt our nation if not attended to through the cure-all of increasing competitiveness in the medical marketplace.

The business remedy, managed care, makes its profits through selling a benefits package to employers and then cutting costs for these benefits through contracting with physicians to provide care for less. It is hoped that senior citizens, the biggest users of government-funded medical care, soon will also be herded en masse into managed care.

We’re talking huge managerial profits here for those managed care companies that intervene between patient and provider. For example, Family Practice News reported that in 1993, Blue Cross of California/Wellpoint Health Networks Inc., a for-profit subsidiary of Blue Cross of California, spent only 70.2% of its revenue for medical care, while its non-profit parent, Blue Cross of California, spent 90.2% of its revenues directly on medical care.

The Florida Medical Assn. reports that almost half of Florida’s health maintenance organizations spend the same 80% or less on patient care that average fee-for-service insurance plans do, while the latter preserve a patient’s right to choose her own physician, not just one contractually joined to an HMO.

What does all this mean to you? Well, let’s say Dr. Z has delivered your babies, assisted at surgery when your son had that emergency appendectomy, helped you find a good nursing home for Aunt Tilly after her stroke. All of a sudden, your company has contracted with a new, cheaper HMO. Dr. Z doesn’t have a contract with that HMO, so he’s history. Meanwhile, you get these chest pains. Dr. Z knew your family history, even knew how stressful your job was. The new doc your company HMO has you see doesn’t know you from Adam, and he’s got to treat four patients an hour. You’re in and out faster than using an ATM, your EKG normal. You felt so rushed you forgot to mention the most important fact of all, about how the chest pains were getting worse as your plant started laying people off and increasing your own workload to make up.

The truth is, being a good doctor takes time. Making profits means more turnaround in less time.

Which is not to say that managed care is without redemptive value. But it will have to have an ethic that somehow interjects more humanity into a system wedded to profit-taking.

The pendulum will probably swing laterally before it returns. So don’t get sick for a few more years.