Practicing Politics

Taking Note

THE NAME OF the game is changing faster than you can say "ahhh," and no mean tongue depressor is going to hold back the course of history. Every facet of the medical world is undergoing rapid transformation. And smack in the middle of this revolution and its concomittant crisis is the state of Massachusetts.

This has all been said before. Doctors, journalists and congressmen have been tossing around a handful of acronyms like "DRGs"--diagnostic related groups--and "HMOs"--health maintenance organizations--for quite some time now. And although the changes taking place in the health care system--in the way doctors are paid and in the way hospitals are organized--are of an unprecedented magnitude, something else is happening as well.

The last bulwark of the old world is giving way. Plain doctoring rest in peace. Boston and Harvard physicians, and physicians across the country, are learning how to play politics and manipulate the media to get their share--just like diplomats, farmers, and terrorists.

It's a matter of style and motives. A new brand of protest is on the market, and physicians are taking note.

Doctors have protested war, hunger, and social injustice before. In the late 1960s, physicians rallied against the Vietnam quagmire with the best of them. But now the issue is economics. Physicians are looking into their pockets and deciding that it's time to seize the hearts and minds of their legislators.

Remember February, 1986. Hundreds of Massachusetts physicians decided to strike. On only three times before had doctor's walked off the job: once in Southern California in 1975, once in Florida in 1984, and once in New York in 1985. The February affair was featured in Boston newspapers and on the 6:00 p.m. news.

Physicians in high-liability specialties complained that malpractice insurance rates were too high, Medicaid and Medicare reimbursements too low, and billing restrictions grossly unfair. In protest, physicians refused to treat patients or accept new cases. A new terminology came into vogue, as orthopedists threatened a "Day X"--a day when they would cease to provide services. Journalists coined the term "pseudo-unions" to refer to Massachusetts chapters of the American Academy of Orthopedic Surgeons Association and the American College of Obstetricians and Gynecologists.

IN THE HEAT of it all, Massachusetts Governor Michael S. Dukakis finally signaled to the frustrated docs that the system would change. It looks like that promise may well come true. A 58-page bill now going before the state legislature will, if passed, vastly alter the structure of the medical malpractice system, by rescheduling insurance payments, limiting delays before malpractice suits, restricting lawyers' contingency fees, and cutting down "pain and suffering" judgments.

So far most of the action has been in the suburbs. But the new attitudes are infiltrating the medical establishment. Doctors everywhere are concerned. Even doctors in major medical centers are grumbling.

Although doctors have taken collective action before, it has not been on this scale. For the last several years physician activism has escalated, as medical societies in Illinois, Maryland, Michigan, New York, and Washington have organized their own marches on "Capitol visitation days" to protest the troubled malpractice system.

Physicians are a powerful force in politics when they act in concert. And Massachusetts is loaded with them--13,970 practicing doctors according to the American Medical Association's latest count. It's not surprising that the system has exploded here.