I'm old enough to remember a time when there were only two people involved in the physician-patient relationship. Today there are thirty-two: thirty-one of them want to get paid and one wants his parking validated and doesn't want to pay the doctor. Go figure.

I'm old enough to remember when socially conscious politicians endeavored to obtain healthcare for all. Today, most elected officials tout health insurance for all. One wonders if the premium-hungry, strip-mining machinery of the for-profit health plans has been conveying the message, "Feed me" to those in or seeking public office.

I'm old enough to remember the original golden rule, but experienced enough to know that today's capitalistic golden rule is, "He who has the gold, rules." The for-profit health plans have the gold.

We live in a world of near-infinite possible futures. Little decisions made today, or not made today, may have a tremendous impact on the future world our children and grandchildren inherit. You, individually and collectively, have tremendous power to influence the healthcare future in this state and nation through your participation in your county, state and national medical associations. Individually, you have tremendous influence if you are a member; you have more influence if you are a PAC contributor, and even more influence if you rise to action or leadership within your medical associations.

Absent the actions of your county and state medical associations, sustained over the last 33 years, you would be paying two to four times as much for your medical liability insurance. Absent the actions of your county and state medical association leadership this past year, you would soon be paying a 2-percent state professional gross revenues tax.

Here are some of the things on the for-profit health plan wish lists, which they will ultimately succeed in obtaining, absent your continued and increased participation in your county and state medical associations and affiliated PAC.

1. Removal of the corporate bar against the practice of medicine, ultimately allowing direct employment of "healthcare providers," including doctors, in for-profit health plan facilities.

2. Expanded scope of practice for all sorts of health professionals, allowing medicine and surgery to be practiced by lesser-trained, lower-paid employees of the for-profit health plans.

3. Strict protocols of care, allowing a cadre of technicians with keypads to administer 90 percent of healthcare.

4. Contracted participation in the "state-authorized" health plan as a condition of licensure, with strict adherence to all payment schedules and contractual "agreements," as dictated by the for-profit health plan, and more. Let your imagination run wild!

LACMA and CMA are not about protecting the "private practice of medicine"; they are about protecting, enabling and enhancing every physician's ability to take the best possible care of each patient. LACMA and CMA believe it's well past time to throw those other thirty people out of the consultation room, so that we may return to just taking good care of our patients. Your own individual actions or inactions will determine the future world we will live in.