Physicians have long enjoyed prestige, power, and autonomy, but the rise of managed care organizations has drastically changed their status. Many doctors are in thrall to the financial well-being of the corporations that employ them, their knowledge and expertise controlled and manipulated in the interest of profit maximization. This article investigates the professional decline of physicians, citing the use of gag clauses, incentives to withhold care, and the breakdown of their authority. In an effort to regain some measure of control, physicians have taken their concerns to the public, supporting state and federal legislation that attempts to curb questionable managed care practices, but this new alliance is unreliable. The author evaluates the history and ultimate failure of California 's propositions 214 and 216, both created to protect patients and physicians. The results clearly suggest that physician influence alone can no longer sway public opinion.



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