Doctors' Unions

The U.S. House of Representatives this week adopted the "Quality Health Care Coalition Act."  This Act exempts doctors from antitrust laws, allowing them to engage in collective bargaining with HMOs, hospitals, and other insurance providers.

The stated idea behind this action is to give the medical profession some of the muscle it has lost in recent years, and thus to allow doctors to fight more effectively against various excesses of managed care.  This bill was endorsed by many doctors, and by the American Medical Association.  It was opposed by consumers' groups, the FTC, nurses, hospitals and employers.

DrRich comments:

The advent of a national Doctors' Union, in my humble opinion, will drive the final nail into the coffin of the medical profession.  

I have nothing against unions, mind you.  Why, many years ago, when steel was still a major industry in America, DrRich was a proud, card-carrying member of the United Steelworkers of America.  Unions have been, and often still are, a wage earner's necessary counterbalance to what otherwise would be a nearly all-powerful employer.

But unions are fatal to the professions.  Professionals by definition have a primary obligation to their "customers," be they clients, students, or patients; an obligation that supersedes every other consideration.  In the medical profession, the primary obligation of doctors is to their patients.  The interest of the individual patient must come first.  Honoring the fiduciary duty to his patient is the doctor's job; that duty, in fact, is the very thing that defines the doctor as a professional.  Indeed, as I have argued in my Grand Unification Theory, the destruction of the traditional doctor-patient relationship is at the core of our growing crisis in health care. 

The funny thing about unions is that they eventually become the primary focus for the loyalty of its members - even when those members are professionals.  This "ethic" - under which the union becomes first, last and always in the minds of its members - was absolutely necessary in the early days, when employers would use ruthless methods to "break" fledgling unions.  The peer pressure - and the implied threat of violence toward members who were less than completely loyal - served to solidify unions in those dangerous days.  This solidarity was absolutely necessary in order for unions to employ their one and only weapon - the strike. Unless all its members honored the strike, that weapon would be useless. This uncompromising requirement for loyalty has endured as the prime directive of all union members, everywhere.  

A professional cannot be both primarily obligated to her client, and at the same time primarily obligated to her union.  Doctors argue that their loyalty to their patients can never be compromised - indeed, the AMA says, the main reason for a doctor's union is so doctors can more effectively advocate for their patients against the HMOs.  But the fact is, unless the doctors' union becomes inviolate in the minds of its members, that union will never be much of a "threat" to the HMO.  It is only the threat of collective action - in other words, a work stoppage - that has the potential of giving a doctors' union the power to bend intransigent HMOs to its will.  For doctors, a work stoppage will necessarily have a harmful effect on their patients.  

DrRich is old enough to remember when teachers' unions were first formed.  He remembers being horrified at the notion that teachers - true professionals - would ever consider going out on strike, and abandoning their students, for higher wages, guaranteed time off, and other personal benefits.  The teachers in those early days, just like the doctors of today, swore ultimate loyalty to their clients - the students - and swore that they would wield the weapon of the strike only rarely, and when they did so they would act mainly for the students' benefit (e.g., smaller class sizes and the like).   And yet, today teachers' strikes have become a ubiquitous problem.  These often lengthy, disruptive, and contentious battles are invariably fought over teachers' wages and benefits - DrRich cannot recall even one example of a difficult teachers' strike being settled only when the intransigent Board of Education finally acceded to the union's uncompromising demand for a reduction in class size.  

Somehow, labor unions always end up fighting for the benefits of their members, and not of their members' clients.  A doctors' union, despite all the pretty assurances, can only end up doing the same.  If doctors embrace a union, they are announcing the end of their profession.

07/08/2000

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