Monday, September 29, 2014

Physicians As Pawns in Health Care Chess Game

The chess board is the world, and the pieces are the phenomena of the universe, the rules of the game are what we call the laws of Nature. The player on the other side is hidden from us. We know that , to our cost, that he never overlooks a mistake, or makes the smallest allowance for ignorance.

Thomas Henry Huxley (1825-1895), A Liberal Education

Physicians increasingly feel like pawns in a society chess game.

Chess is a game played by two persons, each with 16 pieces, on a chess board. Each person has eight pieces: one King, one Queen, two Bishops, two Rooks, two Knights, and eight Pawns.

The Pawns are the most numerous pieces on the board, also the weakest. They can be moved one square at a time vertically but be captured diagonally. In the society chess game, pawns are defined as something or someone to be used or manipulated for another person’s purpose.

The most powerful piece on the board is the Queen, who can move any unobstructed distance in any direction, The most important piece is the King. The object of the game is to trap the opponent’s King so that its escape is not possible.

The endgame is to trap the King. Then the King is said to be checkmated.

The other pieces on the board are limited in the directions they can move, vertically, horizontally or diagonally.

For the purposes of this blog, the Government is considered the Queen, and the Marketplace is considered the King.

The idea is to checkmate the King and his pawns, consumers and physicians.

In the endgame, the King cannot move and cannot jump over another piece.

I have, of course, oversimplified the very complex health care chess game, but there are parallels.

It is a game that can be won or lost by the moves of its various pieces. It pits one player, the Government, against another player, the Marketplace. It limits the moves of one player against another.

The Government is most powerful player because it is the biggest payer with 117 million Americans under its direct control (50 million in Medicare, 65 million in Medicaid, and 7 million in the VA).

The King, who oversees multiple moving parts, is in the process of being checkmated by rules and regulations and an all embracing health care law.

Physicians regard themselves as being used and manipulated as pawns in the process. They feel, well, rooked.

Physicians are trying to escape by contracting directly with consumers and businesses, but they fear the endgame is in sight, in which they will be mere pawns of the Queen.

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