Proposition 86, the Tobacco Tax Act of 2006, proposes to raise California's state cigarette tax by $2.60 per pack (13 cents per cigarette). If it passes, California smokers would face a total tax of $3.37 per pack (up from 77 cents per pack) starting Jan. 1, 2007.

Revenues are projected to be about $2.1 billion in 2007 and slated to fund several public health programs, including affordable health insurance for every child, improved emergency care, tobacco prevention programs and chronic disease research.

However, amid all those "motherhood and apple pie" concepts is an exemption for hospitals from antitrust laws--hospitals would be given the ability to set and regulate doctor fees and doctor duties. Backed by the California Hospital Association, Proposition 86 would give hospitals monopoly power.

Excerpting from Section 1797.304 on Pages 28 and 29 of the proposition: "A hospital, in its sole discretion, may utilize (tobacco tax) funds it receives under this Chapter to provide compensation if ... the method and the amount of compensation to any physician or physicians is in compliance with applicable law ... to the extent that any hospital or hospitals work cooperatively in developing and implementing the plans for providing emergency services ... such hospital or hospitals shall incur no liability under federal or state antitrust or other anti-competition laws prohibiting combinations in restraint of trade..."

What a great idea--change the law so that restraint of physician trade becomes legal. Proposition 86 would allow hospitals to set work schedules and determine payments for physicians. Who loses here? In the short run, physicians. In the long run, patients. This proposition will hurt access to healthcare by forcing physicians to abandon the emergency medical care system. Thus, the bill will have the opposite desired effect on healthcare in California.

The tricky issue physicians face is that the remainder of Proposition 86 is filled with good-intentioned ideas to improve access for all, especially children. So how could physicians even think to not support such a positive effort? How could they not support obvious and desirable healthcare measures for the public?

What a brilliant strategy--sneak in the small, but far from innocent antitrust codicil among all the noble ideas of the proposition. The CHA's hope is that physicians will be outsmarted and outmaneuvered.

A drastic swing in the pendulum of power would place too much control in the hands of hospitals. The CHA would have physicians become unable to charge a usual, customary and reasonable (UCR) fee. Furthermore, that common phrase would no longer be the jargon of physicians. A new CHA-redefined and regulated UCR would stand as a standard of conglomerate corporate hospital industry propaganda.

Physician consultants would labor at the sole discretion of hospitals, unable to negotiate mandated stipends for their good, fair and worthy work efforts. The many hidden costs and excessive laborious duties of a specialist being on call would be ignored.

Fair reimbursement for dedicated time spent on call in rendering emergency room services would become a forgotten promise of the past. Any concept for future tort relief would be thrown out the window. Physicians would become indentured workers, subservient to a dominant corporate influence. Physician practice patterns would eventually change and patients in need of emergency care would feel abandoned.

Ladies and gentlemen of the medical profession, fellow physicians and colleagues, we must recapture the concept of our professionalism in the public mindset. We must quash the perception that the corporate hospital industry is spinning. "Usual, customary and reasonable" is the physician's billing prerogative, not a corporate industry calculation.

The public, media and political sectors need to be convinced that corporate hospital interests are attempting to increase profits by breaking the backs of physicians with low reimbursements. The CHA is enabling hospitals to shirk their fiscal responsibilities with this legislative exception, a proposition-generated loophole, a shameful tactic that would end their legal obligation to pay just, honorable and reasonable physician fees.

If physicians dare object to Proposition 86, the CHA might paint physicians in the public eye as greedy fee mongers, uncaring for the public need and unwilling to compromise for the greater good.

This dilemma urgently needs to be solved. Physicians could support the proposition, remain neutral to its passage or openly oppose the measure. Educating our patients not to be fooled by the big-moneyed advertisements on television, paid for by rich corporate interests, would be difficult, but not impossible. Educating our patients about the true nature and consequences of Proposition 86 is mandatory.

Just how do you feel about this? What do you want LACMA to do? E-mail me at president@lacmanet.org or call 213/683-9900. Do it today. November's vote on Proposition 86 is just weeks away.