by Bob Braile, D.C.

Soon his business did grow. He eventually bought the barber shop he worked in, and then he bought the building the barber shop was in. Soon, he owned a good portion of the block and Grand Avenue. Angelo believed in the American Dream, and for him it was coming true. But, he also learned that the American dream didn't come easy, and it wasn't free. There were mortgages to make, taxes to pay and expenses to keep the business running. But there was one other thing he hadn't expected that wasn't suppose to be part of the American Dream.

In this Italian neighborhood, as in others, there were some "wise guys" who had a different idea of how the American Dream was supposed to work. They believed they could make a living by taking money from all the local shop owners in exchange for "protection." Basically, if the shop owner paid his percentage, his business was left alone and he could survive. If, however, the shop owner refused, either the customers would be scared away until there was no business, or an unfortunate accident would befall his shop.

This was the unfortunate reality Angelo, and many other new Americans, had to live with. Some shop owners survived these times, while others fell prey to the wise guys and lost their businesses. As time went on though, law enforcement got tougher on this type of extortion, and the wise guys eventually found themselves either in jail or out of business. This was the final ending of the "Protection Rackets." Or was it?

Health Reform is the hot topic of the day. In Florida, Gov. Lawton Chiles has already started a series of sweeping changes that are having a profound effect on the health care delivery system in this state. The key to much of this reform is the concept of "Managed Care." Under this system various plans are suppose to compete for their share of the market by offering packages of doctors at certain fees. In theory, this setup should lower the cost of health care while maintaining quality. The reality of the situation is much different, and in many cases insidious.

Under this new reform system, insurance companies now develop "lists" of doctors who they call their "preferred providers." Any consumers covered by these insurance companies offering managed care are in many cases told they can only go to the doctors on their "list." Some plans do allow you to go to other doctors, but you as a consumer have to pay considerably more for this ability. What this type of system sets up is competition among doctors to get on these "lists." A doctor who gets on a good list is assured a large supply of potential patients. Doctors unable to get on these "lists" are left out in the cold.

For decades the doctor who cared about his or her patients the most - the one who gave the best loving service - got the most referrals and hence had the biggest practice. The incentive was to serve your patients as best you could. Under this new managed care setting, the incentive is now for doctors to get on as many "lists" as they can. Many doctors have even hired full-time staff personnel designed to do nothing except sweet talk insurance companies and employers to get the doctors on their "lists." There are even numerous companies running around collecting huge sums of money from doctors by promising they can get them on these insurance lists. Some of these companies even charge the doctor a percentage of his or her fees when the doctor sees a patient from certain plans. If this is not the modern-day rackets, I don’t know what is.

Although most doctors have probably never had some seedy-looking characters show up at their office and demand a piece of their action, all have probably been approached by some of these managed-care groups. No, these new wise guys don't threaten their lives, but just like the wise guys from my grandfather's day, these wise guys threaten doctors’ very livelihood and existence if they don't pay. The only difference is now these gangsters have dressed up in the suits of respectability, and have befriended insurance companies and politicians.

There are even some entrepreneurs who for a large monthly fee will get doctors and pharmacists on these "lists" by making donations to the list keepers or employers, favorite charities. And if the doctor stops paying his name is just as quickly dropped from the list. What has happened is this new reform system has created legalized racketeering!

No matter the trappings or fancy facade, managed care is nothing more than protection rackets. Likewise, the people who run these groups are nothing more than wise guys in business suits. At present, these wise guys have gained some respectability. They have gotten the support of some of our elected officials, as well as the insurance industry. Why else do you hear radio commercials paid for by insurance companies trying to convince you that "Any Willing Provider" is bad for you. In other words, they are trying to say it is better for you to give up your free choice. In truth, if "Any Willing Provider" does finally come to pass, it will effectively end this new form of protection rackets. I urge everyone to support your right to choose you own doctor by supporting "Any Willing Provider."

As in the days of Angelo, the new wise guys and this managed care scheme will some day come to pass. As soon as the public steps forward and says no, as soon as our government realizes that consumers are smart enough to choose their own doctors, these new "Protection Rackets" will come to an end.

THE END