By Eric E. Shore, D.O., M.B.A., F.A.A.F.P.

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Having recently attended the panel discussion at the Adam's Mark, I came away with mixed feelings because while there was significant disparity among the physicians in the audience, it was not until I reviewed the text of the different approaches taken by the panelists, and ruminated upon them that I realized that there is, in fact, no significant disparity among all four approaches. This takes some explanation, so let me begin by asking readers to clear their minds and be willing to accept a new paradigm of the delivery of healthcare.

The "MISSION" of any healthcare delivery system is to provide, as efficiently and conveniently as possible, the best available healthcare to anyone who wants and needs it, at affordable prices (the four P's). Included in this mission is the reality that providers need adequate compensation for their work, and a feeling of empowerment. Patients need a like sense of empowerment along with a feeling of caring, and customers (i.e. payers) need to feel some sense of a downside limit to their liability. It is in light if this "Mission" that I offer this perspective of the panelists views.

Each approach championed in the discussion has its merits. Socialized medicine has the virtue of simplicity. A single payer system, while not necessarily efficient, at least removes the incomprehensible morass of frequently contradictory rules, regulations, and edicts with which we all need to deal today. This would significantly decrease the "hassle factor" among providers and patients alike, as well as decreasing some costs by eliminating the multiplicity of billing and collection routines.

Unionization has the virtue of representing, and thus empowering providers in the face of an increasingly powerful and effective control of purchasing power. Insurers, the government, employers, etc. are much more effective in dealing with physicians than the other way around. There are many physicians with whom they can deal, while there are a relative handful of payers. This gives the payers the market power. Unionization goes a significant distance in equalizing this situation. It should not, however, be left for "Organized Medicine" to control. The last four decades have shown the AMA, AOA, and other professional groups to be splintered, politically diverse, and effectively impotent to produce anything but rhetoric and self flagellation.

Physician-owned and operated Insurers and Corporate providers can be treated a single approach because they are simply two segments of the same approach - production and distribution. Each has its place within the aforementioned healthcare system. Still, how do all of these fit together into a unified whole?

A unified, large scale Information System using EDI technology could effectively provide single payer benefits to providers without the need to vest all of the market power in a single place. If each provider had only a single set of rules, and a single form to submit, electronically, per service, with the centralized Information System providing any necessary conversion of the data into formats required by individual payers, then the effect would be nearly the same as a single payer system, while maintaining the benefits of a free market. If providers were part of corporate entities, each of which contracted with payers from a position of strength (financial, managerial, and HR), the necessity for collective bargaining would be obviated, while its benefits would still be realized. And, finally, provider-owned insurance companies, acting as distribution channels for healthcare, would complete the picture, thus making providers once again competitive in the healthcare market.

One final note to those who would say that we, as providers, haven't the financial strength to compete against giants like Aetna/US Healthcare, Cigna, etc. With all of the aforementioned elements in place, and physician executives (those who have substantial backgrounds in both clinical medicine and business) providing full time upper level management, we would compete where we could, but cooperate where we must, as well. These companies are in business to make a profit. If we can contract with them, and provide the services they need at lower cost and higher quality, as well as greater customer (patient) satisfaction than they could do it themselves, they would be happy to outsource the services. This would cut their own costs, and allow them to become more profitable, keeping their shareholders happy.

A WIN-WIN-WIN situation.