Again, why are you preaching to the choir? I just told you the union would not immediately serve to negotiate pay until we switch to a universal type healthcare system. It will also be there to protect physician interests in the moulding process of such a system, something the AMA is not capable of doing. In the meantime such a union could be fighing to gain back control of the profession. Unionizing is not illegal.
BTW, there are lobbies and legal challenges to exempt physicians from antitrust limitations in the present system for the purpose of negotiating pay. An aggressive union could pursue that too.
Hmm. There is still some miscommunication here. What's confusing me is that you think that physicians can form a union that can actually do very much for physicians. This is an active area of law (changing to & fro) with not much for physicians to celebrate. While there are organizations that call themselves unions and appear to represent physicians, but, as far as I can tell, they don't act like unions in a strong sense. While you can join together with other physicians to negotiate fees with insurers in some states like Texas (yay!), this does not appear to be a union in the sense that you seem to be suggesting (there is some limited authorization for small bands of physicians to negotiate with insurance companies). It makes no difference how many "payers" there are. There are several reasons why unionization of physicians is difficult, starting with the fact that any near-term universal care will not make physicians government employees and going on to the fact that a worker with management or supervisory responsibility generally cannot be represented by a union.
Even many nurses (who are supervised by physicians) cannot unionize:
http://www.washingtonpost.com/wp-dyn/content/article/2006/10/03/AR2006100301535.html
Some Workers Change Collars
NLRB Rules Some Nurses Are Supervisors, a Potential Blow to Unions
By Dale Russakoff
Washington Post Staff Writer
Wednesday, October 4, 2006; Page D01
The National Labor Relations Board ruled yesterday that nurses with full-time
responsibility for assigning fellow hospital workers to particular tasks are supervisors under federal labor law and thus not eligible to be represented by unions.
The 3-to-2 decision, long awaited by unions and businesses, sets a new standard for determining who is a supervisor in the modern economy and could have significant implications for efforts by labor unions to organize nurses in the fast-growing health-care sector. Under federal law, supervisors do not have the right to belong to unions.
Union leader John Sweeney condemned the ruling as a blow to labor. (By Joseph Kaczmarek -- Associated Press)
Labor leaders decried the ruling, with AFL-CIO President John Sweeney saying it "welcomes employers to strip millions of workers of their right to have a union by reclassifying them as 'supervisors' in name only." The labor-backed Economic Policy Institute said the new definition could affect 8 million
workers who give direction to fellow workers in fields ranging from construction to accounting.
...
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Physicians forming any kind of union that drives up physician prices to insurers or Medicare will meet swift and aggressive legal action by the FTC, NLRB, and possibly others. Again, the only viable alternative I see is to make physicians employees of large companies that negotiate their fees with insurers and the government. Even this method would require extensive legal maneuvers.
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http://jama.ama-assn.org/cgi/content/abstract/286/1/83
An Analysis of Physician Antitrust Exemption Legislation
Adjusting the Balance of Power
Fred J. Hellinger, PhD; Gary J. Young, PhD,JD
JAMA. 2001;286:83-88.
Current antitrust law restricts physicians from joining together to collectively negotiate. However, such activities may be approved by state laws under the so-called state action immunity doctrine and by federal legislation under an explicit antitrust exemption.
In 1999, Texas became the first state to pass physician antitrust exemption legislation allowing physicians, under certain defined circumstances, to collectively negotiate fees with health plans. Last year, similar legislation was introduced in the US Congress, in 18 state legislatures, and in the District of Columbia.
"Some physicians already have the opportunity to collectively negotiate. The National Labor Relations Act enacted in 1935 empowers employees to join a union and collectively negotiate.3 Of the 700 000 physicians in the United States, an estimated 100 000 are employees.4-5 Physician antitrust relief legislation is designed to help the 600 000 physicians who are not employees to collectively negotiate with managed care plans.
"In June 1999, Texas became the first state to pass a physician antitrust exemption law when Gov George W. Bush signed Senate bill 1468.6 Last year, physician antitrust exemption legislation was introduced in 18 state legislatures and in the District of Columbia.
It passed only in the District of Columbia where its implementation was eventually blocked by the city's financial control board.
...
"Moreover, a recent decision by the US Supreme Court may make it more difficult for physicians employed by hospitals to join a union and may add momentum to efforts to pass physician antitrust exemption legislation.21 The case focused on whether certain nurses employed by a health care facility were supervisors for purposes of the National Labor Relations Act and thus ineligible to join a union. The court determined that the nurses were supervisors, and this decision may be used by hospitals arguing that physicians on their payroll are supervisors and ineligible to join a union. ...
"Physicians in a group practice may collectively negotiate fees with managed care plans without being subject to charges of price fixing because a group practice is viewed as a single entity by antitrust officials, and it is impossible for a single entity to conspire with itself to fix prices. It is when physicians from different practices join together to negotiate fees with a managed care plan that physicians may be subject to charges of price fixing.
...
There is some progress being made in this area. There is an "independent labor organization" for physicians that is separate from AMA but was created by the AMA
http://www.ama-assn.org/ama/pub/category/2384.html
The AMA founded Physicians for Responsible Negotiation, the only national, independent labor organization created specifically for physicians. PRN was created on the basis that it understood the shared values of the physician community and was committed to protecting medicine's high standards of ethics and professionalism. Physicians who chose to join PRN agreed not to strike or withhold essential medical services. PRN was designed to restore the integrity of the patient-physician relationship, and to ensure the quality and integrity of patient care, reinforce the physician's historic role as patient advocate and make it economically viable for physicians to practice quality medicine. PRN was created by the AMA to empower physicians in an ever more challenging environment. PRN was designed to provide physicians with the information, resources and tools needed to stand up for their profession, for patients, and for quality health care. In early 2004, the AMA and PRN mutually agreed that PRN should operate as an entirely independent organization with no connection to the AMA.
Educational resources, including Antitrust 101;
Additional antitrust information; and
AMA Advocacy efforts
http://www.ama-assn.org/amednews/2002/08/26/prsd0826.htm
http://www.prnseiu.org/aboutprn/index.cfm
http://www.doctorscouncil.com/ourlocal/
http://www.physiciansnews.com/spotlight/302.html NJ passes physician joint negotiation law
http://www.managedcaremag.com/archives/0006/0006.states.html
"Passing a physician negotiation bill is one thing. Implementing it is another. After months of public comment, Texas Attorney General John Cornyn and the Texas Medical Association finally seem satisfied that rules that took effect June 6 can make the state's unique physician negotiation law work the way that it's supposed to.
"Under federal antitrust law, physicians may bargain jointly only if they are financially or clinically integrated. SB 1468, signed last June by Texas Gov. George W. Bush, allows independent competing physicians to negotiate collectively with health plans and avoid violating federal antitrust laws.
"
To get around antitrust prohibitions, the Texas law requires negotiations to be conducted under state supervision -- in this case, the attorney general. <<< Good luck scheduling your appointments with the AG.
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It looks like the courts and legislatures are giving physicians some very limited rights to negotiate with insurance companies, but no blank check and certainly nothing approaching the collective bargaining rights of, say, factory auto works have. I don't see this changing with single-payer either. It looks like the courts and legislatures occasionally throw physician organizations bone, but nothing sweeping thus far. Maybe efforts like yours will change that over time. Let's see what happens.
That being said, in Texas, it looks like the TMA is going a pretty good job looking out for physicians. Maybe medical associations in other states can share ideas with Texas to improve conditions in each other's respective states:
http://www.texmed.org/Template.aspx?id=4927
Practice Viability
"TMA has earned $1.5 billion in retrospective and prospective relief for physicians through its class action federal antiracketeering lawsuits against Aetna, CIGNA, Humana, WellPoint, Prudential, and Health Net. The association and several other medical societies won significant settlements against those health plans. Throughout 2005, TMA's legal and practice management experts monitored the companies' compliance with the settlements and told physicians how to file complaints when the insurers strayed from their agreements.
...
"You cannot maintain a viable medical practice unless you are treated fairly by insurance companies and other payers. Thanks to advocacy initiatives by the TMA Council on Socioeconomics with the Texas Department of Insurance in 2005, UnitedHealthcare was fined $4 million in early 2006 for violating the state's prompt payment law.
-- just kidding. No, we shouldn't sit around, but let's not spin our wheels. Let's build organizations that don't get tripped right out of the gate.
