Healthcare delivery can never be considered an industry completely subject to all the antitrust rules of a free market. Unlike other industries that are not conflicted with moral dilemma, health keepers--thankfully--are not willing to refuse life or death services to those who cannot pay. The time is ripe for physicians to unite behind a renewed effort to urge Congress to pass an antitrust exemption bill for healthcare.

There's an important drama playing out in the emergency room behind the scenes and beyond the trauma cases. It's about balance billing. An out-of-plan insured patient meets a doctor for the first time in the ER. The patient doesn't really want to be there, but chances are the doctor is going to get stiffed with the bill.

The decision to restrain physician billing for services rendered in emergency care is a barrier to free trade in an open market economy. The governor's ban is definitely illegal and contrary to the opinion of the California judicial system.

Amid all the "motherhood and apple pie" concepts in Proposition 86 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.

The woeful state of physician reimbursement deserves careful study. Just how did we get here and how can we fix it?

Read a personal message from a budding physician of the future in this special "Holographic Internet Transmission" to Ralph Di Libero, MD.

This first detailed and authenticated medical education quality study, "The Flexner Report," became a watershed event for healthcare delivery. With ample financial and political backing, the report gained wide acceptance and drove future economic considerations in healthcare.

The second medical ecolo-nomic watershed event was employment-based health insurance. This type of insurance changed the evolutionary course of healthcare delivery in the United States.

The third medical ecolo-nomic watershed event was the passage of Medicare and Medicaid entitlements in 1965. Federal Medicare and Medicaid (Medi-Cal in California) programs soon blossomed, and the federal government immediately appointed itself as an organizer of healthcare delivery.

There is nonpartisan momentum in the media today for universal financing of healthcare. Is this health reform momentum proceeding in a purposeful fashion toward a defined program or is it just a lot of talk buzzing about in heat-accelerated but random Brownian motion?

The fourth watershed event to change the direction of healthcare delivery was government cost-cutting and rationing legislation that produced diagnosis-related groups in 1985.

The global marketplace of today will be the only marketplace of tomorrow. In 2010, the medical ecolo-nomic influence of globalization rose to a political force sufficient to reshape the course of healthcare delivery within the U.S. Globalization, therefore, is and was the fifth watershed in the great American medical ecolo-nomic evolution.

To understand California's current healthcare environment, it is first necessary to go back in time and learn how the concerns of three basic groups--patients, doctors and third-parties--developed, interacted and progressively evolved organized healthcare delivery. These lessons from history inform our future.