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A New Move in Bend's Medical Turf War 

Judging from the tone of the front-page story in yesterday's Bulletin, you'd assume St. Charles and local physicians have come up with the magic cure

Judging from the tone of the front-page story in yesterday's Bulletin, you'd assume St. Charles and local physicians have come up with the magic cure for what ails our local health care system.

The doctors and St. Chuck's have joined forces "to adopt a shared vision for improving health care in Central Oregon," the story reads. "The group of physicians, known informally as the Physician Alliance, and the board of directors of Cascade Healthcare Community, the parent company of St. Charles hospitals, have committed to working together to create an integrated health care delivery system that would enhance care, reduce costs and improve the health of the community."

Reading between the lines of this syrupy rhetoric, it's easy to see what's really going on here: St. Charles has made a shrewd strategic move in its ongoing war against Bend Memorial Clinic.

"I think our community is sick and tired of the rancor in the medical community that has been so evident," said Dr. Michel Boileau, a leader in organizing the physicians' group.

"Rancor" is a bit of an understatement; BMC and St. Charles have been going at each other like the Crips and Bloods for years, battling over the medical turf of Central Oregon. The results have not been healthy for the innocent bystanders (patients) -duplication of services, lack of cooperation and communication among doctors and facilities, unnecessary and expensive and sometimes redundant testing.

With its latest move, St. Charles has thrown down the gauntlet to BMC's doctors: Either join in our effort or look like you're against better medical care.

"We have a chance to build something new here, and all physicians who agree with the philosophy are invited to join," Boileau said.

Mike Bonetto, a spokesman for Cascade Healthcare Community, was considerably more blunt:

"What we've put out there is mom and apple pie. If you're not aligned, you're going to have to explain why. You're going to have to defend that decision to your patients."

It will be nice if this initiative succeeds in ending the regional medical turf war. But in the long run we think it's going to fail, because it doesn't address the root problem: our profit-based, competition-driven medical care model.

Under that model, doctors are, in effect, piece-workers; they get paid for each patient they see or procedure they do, rather than being on a salary (unless they work at the Mayo Clinic or a few other unusual establishments). So their financial incentive is to shuttle patients in and out of the office door as fast as possible.

Because the present model puts hospitals and clinics in competition with each other, each competitor feels it has to have the same high-tech gizmos its rivals have. If one of them has a CT scanner, the others have to get CT scanners too or risk losing business to the competition. If one has an MRI machine, they all have to have an MRI machine.

Since that hardware is too expensive to just sit there, doctors have to make sure it gets used - the more often the better. And as a further motive to make sure it gets used, the doctors themselves often are part-owners of the facilities that do the CT scans and MRIs.

The "free marketplace" model of competition and profit maximization supposedly is what made America great, and in many ways it has. But in the area of medical care, that model has failed totally. Whether America's political leaders have the imagination, or the balls, to replace it with something that makes more sense remains to be seen.

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