Dr. Richard Corlin
Title: President
Organization: American Medical Association
Background:

Born in Newark, N.J., and educated in his home state at Rutgers University and at Hahnemann Medical College in Philadelphia Served as Lt. Commander in U.S. Public Health Service's Heart Disease and Stroke Control program before moving to West Coast for a gastroenterology fellowship at UCLA Joined area medical associations and began moving up the ranks Attained presidency of Los Angeles County Medical Association in 1978 and the California Medical Association in 1992 Switched his focus to national medical issues Reached presidency of the AMA in June Still maintains a gastroenterology practice in Santa Monica and is an assistant clinical professor at UCLA's School of Medicine.

Role in Patient Rights Issue:

As a top-ranking AMA member, spent last several years formulating the organization's position on patient rights Last fall, engaged Sen. Slade Gordon, R-Washington, in an impromptu hour-long radio debate Republican senator later lost election by less than 2,500 votes This helped Democrats take control of the Senate this year and bring the current patient rights bill forward Now finds himself on the front lines, testifying before Congress in support of the bill that finally cleared the Senate in late June Last week, went on lobbying trip to New York to congressional districts held by the GOP as the House gets ready to debate the bill.

Dr. Richard Taw Jr.
Title: President
Organization: American Private Physicians Association
Background:

Los Angeles native Attended Occidental College and earned a medical degree from The Johns Hopkins University School of Medicine in 1970 Pursued specialty in cardiology Appointed assistant professor at UCLA School of Medicine in 1975 and director of Non-invasive Cardiology Laboratory Disturbed by the encroachment of managed care, founded the American Private Physicians Association, a group of mostly West Side doctors with no managed care contracts Maintains private practice in cardiology in Santa Monica.

Role in Patient Rights Issue:

As founder and president of the APPA he has advocated a radically different approach to patient rights focuses on freedom of patients to make own health care decisions, choose own providers and choose method of finance Group, which has grown to 150 doctors, publishes various reports aimed at assisting businesses and consumers in navigating their way through health care industry Believes the current debate on a patient bill of rights is irrelevant to core problems Claims that giving patients an expanded right to sue will lead to higher insurance costs Advocates loosening restrictions on medical savings accounts and requiring all companies that offer HMO coverage to also offer MSAs Advocates converting employee Medicare trust fund contribution to an individual health care retirement medical savings account to be used upon retirement.

Local Leaders Clash on Reforming Health Care System

How do you fix something that's broken, especially something as large and complex as the country's health care system?

If you ask Dr. Richard Corlin, a Santa Monica gastroenterologist who has risen to assume the presidency this year of the American Medical Association, you make legislative changes, piece by piece, year after year.

If you ask Dr. Richard Taw, a Santa Monica cardiologist who is the founding president of a group called the American Private Physician Association, nothing less than a wholesale restructuring will do.

As the patient rights debate heats up in Washington with the Senate's passage of the Kennedy-McCain-Edwards version of the legislation, these two local doctors personify the drastically different approaches being debated to cure the country's sickly health system.

"The AMA embraced HMOs and managed care, and it was a huge mistake," contends Taw. "The patients' bill of rights is a useless exercise that will make things worse."

The AMA, the largest medical society in the nation, is also among the most powerful of special interest groups, and Corlin has worked his way up its lengthy management ladder for 20 years.

Established professional

A former president of first the Los Angeles County and later the California Medical Association, the gastroenterologist is both amiable and respected and in his current post the very personification of the medical establishment.

That establishment has made passage of a patient bill of rights among its highest priorities over the last several years, a key component of which includes increasing the liability of insurers through increased exposure to damages in federal and state lawsuits.

"There is not a group that is more risk averse than doctors, but by the same token we argue everybody should be held accountable for what they do," argues Corlin. "(Managed care insurers) deal in the medical decision-making process without the accountability that everyone else in the process has."

As AMA president, Corlin is on the front lines of that debate, testifying before Congress and traveling to the districts of GOP representatives in an effort to pressure them as the House takes up the bill later this summer.

But he doesn't have to go far to find one of his chief critics. After all, he rubs shoulders with Taw at St. John's Health Center, the highly-respected Santa Monica hospital where they are both on staff.

Corlin says they also refer patients back and forth to each other, and he refuses to publicly criticize Taw, noting he is a "good doctor" with a "different point of view."

Taw is not quite as restrained about the colleague he has known for 20 years.

"I respect him, but he is an AMA politician who must deal with AMA issues. And their position is not the position of the vast majority of physicians in his community."

Taw an organizer

Taw founded the APPA in 1994, disturbed by what he saw was the intrusion of managed care into the physician-patient relationship. The 150-member group is founded on the principle that consumers should have absolute rights to make their own health care decisions and select the provider and financing of their choice.

The group advocates giving patients direct control over their health care dollars through the expansion of such mechanisms as Medical Savings Accounts, in which patients would deposit pre-tax dollars for everyday medical expenses while buying casualty-type insurance for catastrophic events, such as a cancer diagnosis or surgery.

Employers, meanwhile, would be encouraged to help pay for health coverage through so-called "defined contributions," essentially cash payments that employees would use as they choose their medical care.

"We need a legislative solution that enhances the freedom of choice of every American employee and retiree," he says.

Taw says that in order to practice this philosophy he does not have any managed care contracts, even with preferred provider organizations, and neither do most of the group's 150 members. But he said he offers discounts to patients who otherwise cannot afford his service, and as a cardiologist accepts Medicare patients.

Dr. David S. Campion, a Beverly Hills internist who specializes in neurodiagnostic medicine, says he joined the APPA because many of his colleagues did so. He also dislikes managed care, but admits he is neither as driven nor as informed as Taw.

"I would say crusade is not too strong a word for him. He feels very strongly about this, but in politics and medicine you can't get anything done unless you feel very strongly," Campion says.

Small in numbers

The APPA is minute compared to the AMA, and though it offers a variety of information that promotes health care outside the sphere of managed care, even Taw thinks that the kind of change he is advocating won't come until 2010 when the majority of Baby Boomers edge into retirement.

Corlin, for his part, scoffs at criticism of the patient rights bill by Taw and others who contends it will only enrich lawyers and thereby raise health insurance costs and lower the number of insured.

He says government estimates put the cost of the bill at just 0.8 percent, "about one-tenth of what HMOs have raised their premiums in the last year."

Wade Piston is the director of government relations for the Los Angeles County Medical Association, its chief lobbyist. He says that both doctors essentially operate in parallel worlds: Taw is the idealist, while Corlin is indeed a practical politician.

"When you are representing organized medicine, you have to deal with the realities that the system as a whole is facing," he says.

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