Insurance and Professional Unification.

This paper is an adaptation from Mr. Norbeck's presentation at the Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery
San Diego, CA-September 23, 2002

(Adapted for Audiologists and Hearing Instrument Specialists)

For those of you who enjoy history, it was 50 years ago today that a young United States Senator made the political speech of his life just 125 miles north of here in Los Angeles to 48.9% of possible viewers-60 million people-and the largest witness to a political speech in world history to that time.

That famous ''Checkers'' speech, and the 325 to 1 positive reaction to it, enabled Richard Nixon to remain on the Republican Presidential ticket with Dwight Eisenhower. How history might have been changed without that speech.

''While most of us are still deluding ourselves into thinking that we are captains of our own ship, insurers go right on treating us as nothing more than hired hands.''

While these were words from one Newport Beach, California physician a few months ago, unfortunately they do express the sentiments of many professionals throughout this country.

I saw a letter recently in a British publication that is as equally dispiriting as it is relevant. ''Look here, your Lordship,'' it began. ''You have broken my business, you have ruined my home, you have sent my son to prison and my wife to a dishonored grave. You have seduced my only daughter. But be careful, Lord Fitz Wallop, I am a man of quick temper. Do not push me too far.''

Metaphorically speaking, isn't that the same pathetic situation professionals find themselves in today? Haven't professionals been pushed to the limit? This is not good for America's patients.

It doesn't surprise me, but it does concern me that the Kaiser Family Foundation survey six months ago found that 87% of physicians report a decrease in morale (a number that may be too low), and that 74% are dissatisfied with the amount of time they spend on administrative paperwork, as compared with seeing patients.

It concerns me that more than 50% of physicians are unhappy with the amount of time they have for non-professional interests, family and friends, and that 75% of physicians believe that managed care has had a negative impact on the way they practice medicine.

With these dismal statistics in hand, it is any wonder that 45% of physicians say they would not recommend medicine to a young person today, mainly because of paperwork and administrative hassles, loss of autonomy, severe intrusions into the doctor/patient relationship, excessive professional demands, and less respect for the medical profession? This is not good for America's patients.

I have worked with and for physicians for 36 years in this Federation of Medicine, and I have never before seen your colleagues so disillusioned-so disheartened-so distraught-so angry-their spirit broken.

With the 5.4% Medicare reduction, ridiculously low Medicaid reimbursements, skyrocketing professional liability premiums, endless regulations-HIPAA and otherwise, and the continued managed care squeeze-a growing number of professionals are so under siege today that they feel their practice is running about two plagues behind Biblical Egypt. This is not good for America's patients.

The time has also come, I believe, for us to stand up and demand from the insurers that physicians be once again called physicians, audiologists be called audiologists and hearing instrument specialists be called hearing instrument specialists. You and your colleagues didn't spend up to one-third of your lives in formal education in order to be called ''providers.'' No proud mother had dreams of her valedictorian child making it into provider school. And you do not deliver a ''product'' to ''consumers.'' Referring to you as a ''provider'' is just another way to dehumanize, demean, and devalue you and your professional services.

And aren't you and your colleagues tired of providing interest free loans to HMOs? That's exactly what you are doing when a health plan doesn't pay your claims on time. Yes, those same people who are robbing you of the joys of practice, stealing your autonomy, assaulting your sense of professionalism-are also playing banker with your money. Can you pay your bills late? Can you borrow money without paying interest?

Wal-Mart self-insures and generates 850,000 medical claims a year. They pay those claims to physicians and other caregivers within 24 hours of receiving them. And HMOs with their vast computer networks need 30-60-90 or more days? Spare me! Is this the system you envisioned when you were in medical school or graduate school? A system that treats health care as a commodity?

So what do we do about these grievances and incursions? Professionals are not as powerless as they think. I would ask professionals, as the German poet Goethe put it, whether they want to be an anvil-or a hammer? We cannot stand idly by and allow insurers to destroy our greatest professions. We cannot allow insurers to dictate the terms under which medicine and health care will be practiced. Your patients deserve better. Our greatest enemy is apathy.

I'm reminded of the old ''man in the street interview'' where the man was asked why he thought people were turned off to politics. ''Is it ignorance or apathy?'' queried the interviewer. To which the man on the street responded ''I don't know and I don't care.''

There is an old story about a rather dispassionate young man who approached the Greek philosopher Socrates and casually stated: ''O great Socrates, I come to you for knowledge.'' The philosopher took the young man down to the sea, waded in with him, and ducked him under the water for thirty seconds. When he let the young man up for air, Socrates asked him to repeat what he wanted. ''Knowledge, O great one,'' he sputtered. Socrates held him under the water again, only that time a little longer. After repeated dunkings and responses, the philosopher asked, ''What do you want?'' The young man finally gasped: ''Air, I want air!''

''That's good,'' answered Socrates. ''Now when you want knowledge as much as you wanted air, you shall have it.''

If we achieve that degree of passion about affecting change, we will level the playing field.

When tough old Andrew Jackson, also known, of course, as ''Old Hickory,'' was dying, someone asked, ''Will he go to Heaven?'' The answer came back: ''he will if he wants to.''

We need that same resolve. Professionals can stick together-be captains of their ship-and win the important battles ahead-if they want to-if they really want to.

I believe that insurers and HMOs will keep right on pushing professionals around for as long as we allow them to do it.

I do not want professionals to be chattels, to be bought or sold in an auction.
I do not want professionals to be so hassled that they have little time for patients.
I do not want professional judgment to be subservient to some bureaucrat's rigid adherence to the bottom-line.

Nor do your patients, the American public.

I do want professionals who are happy and proud again being professionals.
I do want professionals who feel good about their role in society and whose professional judgments prevail in healthcare decisions.

Professionals are not as powerless as they think. However, professionals today suffer from too much pluribus and not enough unum. How tough is the landscape out there? Unless we change it, Death Valley has a more appealing terrain.

You must remember one compelling certainty: If professionals join and work together, the future is yours. If you don't, the future is theirs.