A Totalitarian System
"The totalitarian system as we know it today may also be called 'managerial capitalism' since the decisions dictated by technical and economic considerations are no longer hampered by the rights of ownership and title holders. Yet it should be emphasized, speaking of 'managers,' that the true technical directors have nowhere acquired the disposing power of technocrats; the real power rests mainly with economic and business managers." This was written by H. Bruggers in 1941 in his "Stages of Totalitarian Economy," in the publication Living Marxism.
This is managed care. The collusion of insurance companies and businesses with the purchased consent of government allows this corporate monopoly to thrive. Our leaders do nothing but make promises for imminent change, while the suffering for all of us-providers as well as patients-gets worse and worse with no end in sight.
Edward W. Hughes, M.D.
Springfield, Mass.
Dr. Hughes is in solo private practice in Springfield.
Medications as Drugs
For many years I have written and spoken about the need for physicians to differentiate between the terms medication and drug. It makes little sense for people to "say no to drugs" (illegal substances) and "say yes to drugs" (medications). Further complicating this issue is the fact that we refer to facilities that dispense medications as drug stores rather than medication stores.
Lewis H. Richmond, M.D.
San Antonio
Dr. Richmond is clinical professor at University of Texas San Antonio Health Sciences Center and in private practice.
Who Pays the Fiddler Calls the Tune"Who pays the fiddler calls the tune." Let me confess: for a long time I thought this was the governing principle of present-day psychiatric practice. But gradually it occurred to me that the predominance of economic considerations need not-in fact, it must not-go unchallenged. Professional values should temper and, when necessary, control financial decisions. Ultimately, an informed, determined citizenry may need to take action through appropriate channels, including the halls of government.
The Caucus of Psychiatrists Treating Patients Covered by Managed Care has been formed to provide a forum for discussion among psychiatrists. Marcio V. Pinheiro, M.D., has agreed to serve as chair but needs many of us to step forward with him. I urge all psychiatrists who treat managed care patients to contact Dr. Pinheiro at 6400 Ridge Road, Suite 5, Eldersburg, MD 21784, by fax at (410)549-5832 or by e-mail at mvp1@ix.netcom.com. To support this effort, simply ask to be listed on the caucus roster.
Joseph S. Silverman, M.D.
Altoona, Pa.
Dr. Silverman has been in private practice in Altoona for 34 years.
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