I am a proud son of the South, and we Southerners know a little something about feuds, grudges and good old-fashioned hate. A feud is more than just a disagreement with hard feelings; a feud is a longstanding chasm where the players often do not recall what started the ill will in the first place, nor can they see a path to resolution without being forced to by God or the law.
In 2005 our magazine took a look at the "Top Four Power Struggles in Healthcare," which we listed then as: Providers versus payers; physicians versus hospitals; free-marketers versus universal-healthcare advocates and employers versus all of healthcare. Since then some of the struggles have died down. Physicians and hospitals still have their differences, but an era of détente has emerged from the clarity that comes with economic co-dependence. Providers and payers are still slugging, but there are just not as many biscuits left on the plate.
In three short years, a few other healthcare feuds have gotten nasty:
4. The healthcare industry versus the consumer. The healthcare industry misnomer for this feud is "engaging the consumer." Well, down South more than a few feuds have started when someone does not want to get engaged. Healthcare yells: Get your blood pressure checked. Get a pap smear. Schedule an annual PSA test. Check out our HCAHPS scores. Be the keeper of your own health records. Consumers want none of it because healthcare is not a service anyone wants—it's one they need. It's a brotherly feud. Those are the worst kind.
3. Marcus Welby versus Dr. McDreamy. It's a battle of stereotypes. Older physicians are paper-loving, time-hogging dinosaurs who would not know the current treatment protocols if you dropped the EMR on their gray heads. Young physicians are slackers playing dress up in white coats, more interested in getting to soccer practice than treating every patient. For the next few years they will work together and the feud will die out naturally, so to speak. But it's venom until then.
2. Isolationist versus globalist. There are some who would like to see the healthcare borders built out of high concrete. Others would like to see American healthcare become a natural part of the global economy. So far the combatants in this feud are still hiding behind the bushes with loaded guns, but as the prices and availability of quality care overseas become more widely known, expect the first volleys.
1. Hospital versus hospital. Hospitals are playing a business version of the old "if he brings a knife, you bring a gun" feud. If Memorial pays the orthopod group X, then Academic pays him X and buys them an EMR. If they buy land to start up an ambulatory campus in the bordering suburbs, then you fire up the lawyers to fight the CON. Steal their docs. Lure their nurses. Put a billboard for your cardiac center next to their parking lot. There are no new customers: just someone else's customers. It's all very civil by outward appearances, but the gnashing and cutting behind the scenes is a street fight. Who are we kidding?
There are actually too many little fights in healthcare to list them all, but send me an e-mail of some of the worst.