Today, nearly three quarters of U.S. physicians are employed by corporations. Fifty-eight percent of current U.S. medical and nursing students do not intend to treat patients in their careers. Burnout and moral injury among practicing physicians is at an all-time high. The cost of healthcare as a percentage of Gross Domestic Product (GDP) in the U.S. has nearly quadrupled since CPoM prohibitions were weakened in the 1970's. Infant mortality rate is on the rise. Life expectancy in the United States continues to drop. Insured people now compose the majority of debtors to U.S. Hospitals.
The profession of medicine, and the nation's healthcare system are in crisis.
The Federal Government has announced a cross-government inquiry on the impact of corporate greed in health care. We believe that any analysis, investigation, inquiry, and ultimately, solution, will fail without being viewed through the lens of the CPoM doctrine.
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The CPoM Doctrine originated during the first Gilded Age at the turn of the 20th century. It is considered by the American Medical Association to be"integral to elevating the medical profession, ensuring the autonomy of physicians and providing an ethical basis for the practice of medicine."
During the early 1900's, well before any significant presence of health insurance companies or the creation of Medicare and Medicaid, mining, steel, and railroad trusts exerted control over physicians through employment. This was deemed unethical by the profession of medicine. The majority of U.S. states codified this into law, allowing patients to trust that their doctor could put their needs first.
The doctrine must be re-interpreted in the context of the outsized role played by the Centers for Medicare and Medicaid Services today.
Private health insurers have consolidated both horizantally and vertically, steadily increasing their influence over the practice of medicine. Well-intended clauses of the Affordable Care Act (ACA) such as regulating the Medical Loss Ratio (MLR) have encouraged vertical integration with Pharmacy Benefit Managers (PBMs), as well as physicians and non-physician practitioners (NPPs) as a method to skirt regulation and increase profits.
UnitedHealth now employs or contracts with one in ten physicians in the U.S. The prolonged outage of UnitedHealth subsidiary Change Healthcare has forced even more independent practices under corporate control. Prior authorization auto-denials of medical care are untenable.
CMS exacerbates this by funneling taxpayer dollars through Medicare Advantage, and so-called "Value Based Care" At the FTC Workshop on Private Equity, Keynote Speaker Eileen Appelbaum advised CMS,
"... I would encourage CMS to think about whether these [value based payments] are value-based or valueless."
Hospitals are lay-corporations. Tax classification as "non-profit" or "for profit" has no bearing on this. Control exerted by a hospital over the practice of medicine is also in opposition to CPoM doctrine. Historical exemptions for non-profit hospitals were justified under the rationale that locally-accountable, charitable hospitals were aligned with the professional and ethical obligation of physicians to put patients first.
This is no longer the case. With few exceptions, consolidated hospital systems bear little resemblance to the charitable institutions of the past. Fewer choices where to work increases power over physicians. The American Hospital Association (AHA) opposes banning non-compete clauses for physicians, forcing a choice between morally injurious working conditions or uprooting families communities. Physicians who speak out risk professional retaliation.
Commoditizing physicians, rather than recognizing the unique roles of the profession in society by weakening the CPoM doctrine and prohibitions in the 1970's effectively handed the keys to the healthcare system to the corporate barbarians at the gate. This, compounded with de-regulation and consolidation of non-physician corporations over decades, has led to extreme and unsustainable violations of CPoM
Thankfully, today's Federal Trade Commission, led by Lina Kahn, and the Department of Justice's Antitrust Division, led by Jonathan Kanter, represents a return to the values embodied by Supreme Court Justice Louis Brandeis, known to have declared,
"We may have democracy, or we may have wealth concentrated in the hands of a few, but we can't have both"
Relative to physicians who take an oath to put patients first, lay-corporations have become behemoths, resulting in an anti-competitive environment for physicians who face moral injury when they are forced to cross their deeply held moral and ethical beliefs on a regular basis by corporate employers, prioritizing profit over patients.
Learn the story of Dr. Ming Lin MD who is fighting wrongful termination after advocating for the safety of nurses, healthcare workers, and patients during the first days of the COVID19 Pandemic.
Hear from psychiatrist and author of "If I Betray These Words: Why It's So Hard for Clinicians To Put Patients First" Dr. Wendy Dean, MD on how the corporate practice of medicine causes moral injury among physicians and healthcare workers. Physicians are put in an impossible situation and silenced as advocates for patients, nurses, and the rest of the critical clinical team.
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