Who would have thought that an organization, whose legacy includes opposition to the creation of Medicare, would be brought to its feet (repeatedly) by a Democratic president who has vowed to remake American health care? Yet this is precisely what happened today in Chicago when Barack Obama took his case to the AMA House of Delegates.
I was one of those present to witness Obama's speech. It was, in my opinion, a masterful exercise of political persuasion. One very sage observer of the AMA, who has been active in the organization for decades and has himself served in one of AMA's top elected positions, told me after the speech that Obama's political skills are akin to Franklin Delano Roosevelt and Ronald Reagan at the height of their power.
Why did Obama get such a positive response from a group of doctors whose political views can generously be described as leaning right of center?
First, he made the case, as he has done to so many other audiences, that the status quo is not sustainable. He analogized U.S. health care to General Motors - that rising health care costs will ultimately bankrupt the country. He told the AMA that "the alternative to ... reform is a world where health care costs grow at an unsustainable rate. And if you don't think that's going to threaten your reimbursements and the stability of our health care system, you haven't been paying attention." In other words, work with me now to make it better, or allow the system to collapse, with dire consequences for physicians and patients.
Second, Obama acknowledged the reasons why many physicians have reservations about health care reform saying, "There's a sense out there among some, and perhaps some members who are gathered here today of the AMA, that as bad as our current system may be -- and it's pretty bad -- the devil we know is better than the devil we don't." To reassure physicians, he promised that no one would be forced to give up their doctor or their own health plan. He skillfully took on the arguments that he knows will be made against health care reform - that it will lead to "socialized medicine" and "rationing" of care or that a public plan would be a "Trojan Horse" for a single payer system.
Third, he clearly laid out his vision for health care reform: health coverage for all, subsidies for individuals to buy coverage from health insurance offered through an exchange, a ban on pre-existing condition exclusion, and paying doctors based on the quality - not just the quantity - of care provided.
Fourth, he was honest about issues where he knew there would be disagreement. He expressed a willingness to work with the AMA on reducing the costs of defensive medicine but told them he would not support a cap on damages. He explained why he supported including a public plan option "to keep insurers honest" but also said he wanted to design a plan that physicians could support.
Fifth, he spoke to issues that physicians care deeply about. He credited the AMA for getting Congress to enact sweeping legislation to allow the FDA to regulate tobacco. He emphasized prevention and the need "to do more to reward medical students who choose a career as a primary care physician." He received a standing ovation when he articulated the frustrations physicians have with health insurance paperwork.
He did two other very important things. He appealed directly to physicians' tradition of professionalism. When describing the incentives created under current payment systems for doctors to order unnecessary tests, Obama said, "That's not why you put in all those hours in the Anatomy Suite or the O.R. That's not what brings you back to a patient's bedside to check in, or makes you call a loved one of a patient to say it will be fine. You didn't enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers. And that's what our health care system should let you be. That's what this health care system should let you be."
And he acknowledged their power and influence of the medical profession and the AMA itself, making an unabashed appeal for their support: "We need your help, doctors, because to most Americans you are the health care system. The fact is Americans -- and I include myself and Michelle and our kids in this -- we just do what you tell us to do. That's what we do. We listen to you, we trust you. And that's why I will listen to you and work with you to pursue reform that works for you."
This had to be music to the ears of a group of physicians whose voices had become increasingly marginalized.
Today's question: Do you think most doctors will rally behind Obama's call for help in reforming the health care system?