Of Lawyers and Doctors

Microsoft, the federal case, has been laid to rest - thank heaven. But the states, or specifically, their attorneys general, are continuing to pursue the software firm in the courts. This notwithstanding numerous polls showing that Americans do not believe the software giant abuses consumers. What is it about lawyers that they can no longer recognise when they are not wanted?

Well, actually, they can. Indeed the gruesome fellows are even capable of a bit of useful introspection. That at least is what one must conclude at the news at the American Bar Association plans to announce the negative results of a national survey about attitudes toward lawyers at one of their own national conventions.*

The study reports that lawyers rank a mere eighth in citizens' confidence, behind doctors (number one), the courts and congress. Among lawyers' sins the pollees listed poor handling of basic client relations, "an absence of attention to communication", and other problems. "Lawyers must be taught the importance of lawyer-client relationships in law school," said Robert Clifford, chair of the ABA's Section of Litigation, in what has to be counted among the understatements of the year. And, says Mr Clifford, "they have an obligation to talk and to work with the public to enhance understanding of our justice system."

Naturally enough, the beleagured ABA also points out the positives in its study. Attitudes toward lawyers and law enforcement generally have improved somewhat since last year. In April 2001, a mere 24 per cent of the public had confidence in lawyers. That number hit 39 per cent in January 2002. This shift the surveyors attribute to a September 11 effect. We knew there had to be a silver lining somewhere.

More details are to be revealed in Boston this week, at the ABA litigation section's annual pow-wow.

Meanwhile, those supposed paragons of virtue, American doctors, are also sending a message of their own, and a blunter one. They are leaving geriatric medicine, or barring the doors of their practices to senior citizens. The American Academy of Family Physicians, for example, recently reported that 17 per cent of family doctors (general practitioners) now refuse Medicare clients.

Especially hard hit are rural communities, already under-served by the physician population. In Washington state, for example, the chairman-elect of the American Medical Association recently testified, an informal poll showed that 57 per cent of physicians are dropping or curtailing their Medicare patients.

The reasons these seeming saints are leaving grannies out on the ice are laid out in an illuminating study by Robert Moffit of the Heritage Foundation.**

Money is the main one. This year Medicare is cutting doctor reimbursements by 5.4 per cent, even though doctors already receive payments that are well below costs for their ministrations to the senior community. This represents the fourth cut since Medicare's physician fee schedules (aka price controls) were put in place over a decade ago. It is also the largest of all the cuts. Then there are the mounting paper burdens of Medicare, which force doctors to hire extra nurses, rendering their practices unprofitable.

How ironic that this slow breakdown of the Medicare system comes at a time when Congress is mulling the expansion of the programme, so that it will also include routine prescription drug benefits. That change will mean that drugmakers, big medical businesses, will find themselves in the purgatory now inhabited principally by small medical businesses (doctors).

But the poor drugmakers don't even have to wait for a new law's passage for their travail to begin. Citizen groups are already assailing them for overcharging on the limited set of drugs that are currently available through Medicare - Johnson & Johnson, the Roanoke Times reports, is being hammered for allegedly overcharging for its arthritis drug, Remicade. New Jersey Citizen Action and United Senior Action of Indiana, the two citizen groups, stand a fine chance of winning lower Remicade prices because they have had the help of a third group, Prescription Access Litigation. In other words, the lawyers.

© Copyright 2002 Financial Times

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