By Jeffrey Barg

During a recreation of the Boston Tea Party, a physician throws money into the Boston Harbor symbolizing the dollars taken out of health care by for-profit entities.

Published January 1998

• React to this article in the Discussion Forum.

On December 2nd, a group of Massachusetts physicians and nurses recreated the Boston Tea Party, throwing the annual reports of for-profit health care corporations into the Boston harbor instead of tea. This event was intended to spark a revolt against market-driven health care, as articulated in the group’s manifesto "For Our Patients, Not for Profits: A Call to Action" published on the following day in the Journal of the American Medical Society. That evening the group, known as the Ad Hoc Committee to Defend Health Care, held a meeting in Boston’s Faneuil Hall with satellite feeds to over 30 remote cites around the country, including Philadelphia.

The Call to Action, drafted by a prestigious group of Massachusetts health professionals including Nobel Laureate Bernard Lown, M.D., CareGroup CEO Mitchell Rabkin, M.D. and Massachusetts Nurses Association President Karen Daley, has been endorsed by over ten percent of Massachusetts’ physicians and nurses, and thousands of health professionals throughout the country. While the initial impact of the Call to Action has been impressive, its ultimate impact and even its future direction remain unclear.

Call to Action

The Call to Action published in JAMA notes that members of the Ad Hoc Committee differ on many aspects of reform, but that there is common ground on the following principles:

• Medicine and nursing must not be diverted from their primary tasks: the relief of suffering, the prevention and treatment of illness, and the promotion of health. The efficient deployment of resources is critical, but must not detract from these goals.

• Pursuit of corporate profits and personal fortune have no place in caregiving.

• Potent financial incentives that reward overcare or undercare weaken patient-physician and patient-nurse bonds and should be prohibited. Similarly, business arrangements that allow corporations and employers to control the care of patients should be proscribed.

• A patient’s right to a physician of choice must not be curtailed.

• Access to health care must be the right of all.

The manifesto calls for (1) a moratorium on for-profit takeovers of hospitals, insurance plans, HMOs, physicians’ practices and other health care institutions; (2) a series of teach-ins and meetings in hospitals, clinics, HMOs, offices, and nursing and medical schools to discuss the health care crisis; and (3) public endorsement of the Call to Action by additional colleagues and by medical, nursing and lay groups.

Pennsylvania’s Involvement

Thus far, the Call to Action has been organized on the state and local levels with loose coordination emanating from Massachusetts. In Pennsylvania, Ad Hoc committees have emerged in Philadelphia and Pittsburgh.

Philadelphia activities included a related Grand Rounds presentation by Walter Tsou, M.D., M.P.H., at Pennsylvania Hospital, a television talk show appearance by Tsou and Ralph Fishkin, D.O., and a meeting highlighted with a live satellite feed from the Boston meeting at Faneuil Hall.

The Call to Action has spawned two collaborating organizations in Pittsburgh: one for practicing nurses and physicians and one for students. The former was organized by University of Pittsburgh psychiatrist Vishwajit L. Nimgaonkar, M.D. and the latter was organized by University of Pittsburgh medical students David Hackney and Ankur Doshi. The three collaborated on an op-ed piece on the Call to Action published on December 13th in the Pittsburgh Post-Gazette.

What’s Next

While members of the various Ad Hoc committees claim to be very pleased with the response to the Call to Action, reactions to it have not been universally positive. And there is a concern that the Call to Action not just be an event, but develop into a full fledged movement, according to Boston internist, Timothy B. McCall, M.D., one of the drafters of the JAMA article.

In a Washington Post story on the Call to Action, Ronald Pollack, executive director of the consumer advocacy group Families USA and member of the presidential commission that recommended a bill of rights for health care consumers, was reported to have called the position outlined in the article as "quixotic." The Wall Street Journal published a diatribe by a Chicago journalist arguing that the Call to Action "represents a counterrevolution, a backlash by a bourgeois medical establishment that’s been hibernating too long, unperturbed by market forces." It concludes: "If managed care so threatens both the single-payer zealots at Harvard and the country-club Republicans in the AMA, it can’t be all bad."

Lee McCormick, M.D., new president of the Pennsylvania Medical Society, is not much more sympathetic toward the Call to Action. In an interview with Physician’s News Digest, McCormick said that there are a lot of points made in the Wall Street Journal commentary that he agrees with. "The Call to Action is attempting to just stop what is happening without offering any alternatives," he said. He views the call for a moratorium on for-profit takeovers as unrealistic and he believes that insurance companies should have the right to contract with whom they want. "Sometimes we delude ourselves how important we are to patients. . . . The price of loyalty to a physician is $25 a month," he said. McCormick believes that managed care as currently structured will not survive because patients are realizing the limitations of the system and that physicians should participate in shaping the coming hybrid between managed care and fee-for-service.

McCall responds that making a broad moral argument is the right approach. "Physicians have failed to get together in the past because we didn’t agree with the final solution, although we agree with what is wrong with the health care system," he said. The point is amplified in the JAMA article itself: "America’s history is replete with examples of powerful social movements kindled by initially unimposing moral voices . . . We believe that our professions’ voices can gain extraordinary resonance when we speak selflessly in patients’ interests."

McCall believes that ultimately there will need to be federal legislation to rectify the situation, but for now the focus will be on educating the public on what is at stake. He anticipates that there will be a national symposium toward that end in the spring or summer.

In Pittsburgh, the Ad Hoc Committee is working toward a symposium in the first quarter of next year. The committee in Philadelphia is working toward a conference this spring.

It is still unclear whether or when the Ad Hoc Committee will become more of a national organization, rather than loosely linked state and local committees, according to McCall. They do not want to upsize too quickly, he said, and the Massachusetts group may well focus on their own state and later use it as a model.

Philadelphia’s Tsou agrees that efforts will continue at the state level in the hope of ultimately providing a model for national reform. Tsou believes that the situation will probably get worse before it gets better. Over the next four years, he predicts that 20 percent of hospitals will close, resulting in 15,000 to 20,000 jobs being lost in the Philadelphia area. Problems of access to health care will grow dramatically and only then will we be ready to go beyond band-aid solutions to the problem.