Americans are accustomed to seeing the interests of doctors and hospitals as different.
Even during the debate over health reform, releases from the American Hospital Association were treated as being from an interest group, those from the American Medical Association were treated as being from professionals.
But that is changing, with profound effects for health costs and care.
We already know, for instance, that when doctors own hospitals they have a conflict of interest. Even if the bias is unconscious, doctors who own facilities order more tests and treatments than those who don't.
This was at the heart of Dr. Atul Gawande's New Yorker profile of McAllen, Texas, which became highly influential in the year's legislative debate. The whole hospital industry quickly pushed back against the perception, and against reform generally, while the AMA came out for the final bill.
With one caveat. They want the Medicare reimbursement cuts meant to bend costs down stricken.
Absent getting their way in Washington doctors will have two ways of fighting these cuts. One way is to stop serving Medicare patients. Many have done so. But another way is to go to work for hospitals. And many have done that, too.
The Nashville Post calls this trend doctors for sale, but it is in fact the same alignment of interests created when doctors own hospitals, only with the roles reversed. Instead of the doctors now manipulating the system for their own interests, they're advocating for their employers.
All of which leads to a health care system that is more like that of the rest of the world, whether or not reform passes, and however things move from here. In the rest of the world doctors are employees and doctor strikes are common. It's the only move left when jobs, pay and conditions are completely controlled from above.
The trend of doctors losing their independence, or giving it up for the joys of business life, seems irreversible. Will doctor strikes follow? And when they do will conservatives call for doctors' unions to be broken?
This post was originally published on Smartplanet.com