Corporate Power and Health Care: Former NYS Assembly Member and Health Committee Chair Dick Gottfried’s Remarks To MSSNY
At Physician Advocacy Day in March, MSSNY Presented the Lifetime Achievement Award to former NYS Assembly Member and Health Committee Chair Richard N. Gottfried, the longest serving member of the NYS Assembly at the time of his retirement.
Following are the remarks delivered at MSSNY’s Physician Advocacy Day in March by Richard N. Gottfried:
In March 1988, after I became chair of the Assembly Health Committee in May 1987, I attended my first MSSSNY lobby day event. I’ve probably attended more of these than almost anyone in the room. It was a key responsibility to share my ideas with you. More importantly, I needed to learn from you. In my 52 years in the Legislature, we’ve never had a physician member. And there is no limit to what legislators – including me – don’t know about your world. You educating legislators was vital to my work, to your work, and to the health of New Yorkers.
I’ve often said at these meetings that corporate power has turned the honored profession of physician into its paid labor. I want to elaborate on that.
For centuries, medicine was practiced by individuals practicing alone or in small groups. It had a limited basis in good science, had relatively little effectiveness, and was not very expensive.
In the early decades of the 20th century, medical care – including hospital care – became more valuable and more expensive. Hospitals and even physician offices became more capital-intensive, adding more cost. As a result, health insurance began to appear.
Many physicians were concerned that the advent of third-party payers would interfere with the doctor-patient relationship. It turns out that they were right.
Health insurance made health care more affordable and accessible, enabling millions to have better and longer lives. But it also introduced a third-party decision maker, deciding whether to pay for what the physician and patient had agreed on, and which physicians and hospitals would be covered at all.
At the same time, health care and hospital care became more capital-intensive and expensive. (My primary care doctor’s EKG machine is a lot more expensive than a stethoscope.) Health care providers saw the need to form larger economic entities: to finance equipment and to deal with large third-party payers. So physicians began to form larger economic entities and become part of hospital-led entities.
Physicians that previously practiced as individual professionals or members of small professional practices were increasingly employees of large provider entities.
It could be much worse. New York has strong laws barring large for-profit corporations from owning hospitals or other Article 28 facilities, and barring corporate practice of medicine. Much of our law is unique among the 50 states.
New York law does allow closely-held for-profit ownership of Article 28 facilities, which is how come two-thirds of our nursing homes are now for-profit. But as far as I know, there are no for-profit general hospitals in New York.
In other states, hospitals are largely owned by for-profit multi-state corporations. Chain pharmacies and retailers like Walmart are hosting health care providers that are not just providers of drop-in episodic are. They are opening multi-specialty facilities that aim to be your regular health care provider. And they are beginning to form corporate entities with large health insurance companies.
In New York, we do have pharmacy-based “retail clinics” and storefront “urgent care” sites. The pharmacy chain rents space to the “clinic” and provides management services and marketing. But this is different from outright ownership, and so in New York far they have limited the scope of the services they provide.
Personally, if I were practicing a profession, I’d want to be part of a large organization, even if only to not have to worry about the phone bill or rent. But I wouldn’t want to have to compete with the economic and marketing power of CVS or Walmart. And as a patient, I am happy that most of the physicians who care for me are part of hospital-based practices. But I would not want them responding to the dictates of a for-profit corporate entity employer.
So, I urge MSSNY to do three things:
First, stand strong in opposition to repeated efforts to breach New York’s laws against large for-profit corporate ownership of Article 28 facilities and weaken our law against corporate practice.
Second, help rein in “retail clinics” so they are limited to drop-in episodic care. Support Amy Paulin’s and Gustavo Rivera’s retail clinic bill (A.3729, S.2942).
Third, support the New York Health Act. We can’t turn the clock back to the days before third-party payers. But we can move forward: away from corporate payers accountable to their stockholders and replace them with a public payer accountable to the public. As you know, the New York Health Act has been amended over the years to include key language – including provisions about collective negotiation and payment methodologies – asked for by MSSNY. I believe Amy Paulin and Gustavo Rivera continue to be open to responding to your concerns. I urge you to support the bill.
Thank you again for our years of working together, and especially for all I have learned from you.
