Monday, June 15, 2009

Obama's homecoming wows AMA

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?


DrJHO7 said...

That's what it's going to take to achieve meaningful healthcare reform: significant sacrifice, particularly of the financial variety - not just on the part of surgeons, anesthesiologists, radiologists, medical subspecialists and primary care physicians, but on the part of businesses large and small, the pharmaceutical industry, the medical insurance companies, the hospitals, the medical imaging providers, the free standing surgicenters, the Hospices, the physical therapists, the durable medical equipment companies...

If the culture of the collective stakeholders is one of compromise through sacrifice for the greater good, then we've got something. The winner would be the patient (all of us are/can be thought of as patients), and down the road, all of the stakeholders, as well.

We live in a culture of greed and blame, however. It's powerful, and easy to fall back into. Compromise through sacrifice implies vision, courage, humility, strength and a sense of common purpose: uncommon attributes of for-profit corporations that report to shareholders.

If the AMA and the ACP and their collective membership answer the calling of President Obama, et al, and jump on board as part of the solution to health care reform - which I think is possible - how long will that commitment last if there are no price controls on pharmaceuticals, if there is no loosening of the grip that private insurers exert, erecting beaurocratic barriers to health care for patients and their physicians in the name of the almighty dollar?

Oops, that brings us back to politics. Priority One: get re-elected, all other priorities expendable. Big Pharma and Big Insura are shoveling considerable coal into the boiler boxes of those who pursue re-election. Will they be capable of compromise through sacrifice if Priority One becomes more vulnerable? I can't answer that, but I have my fears.

I also can't speak for other physicians, but personally, I agree with the President's assessment that the present situation of our health system is financially and morally unsustainable, and that reform is not an option, but a mandate. let's see where it goes from here...

Jay Larson MD said...

The devil is in the details. If current barriers to delivering patient care are not improved, it will be an up hill battle for physician support. Hopefully physicians will stay committed to their professionalism and focus on what is important for their patients.

jfddoc said...

I agree...we need more details. I was disturbed to see attacks on the AMA when it appeared that they were not in support of the "Public Option." I hope the politics does not co-opt the professionism of physicians and the AMA.

Robert J. Sobel, M.D. said...

There is no doubt that the details to come will determine whether we are moving in the right direction. I share the concerns of Dr. JH07 regarding the entities within our health care pie who have accounted for much of the recent growth. Unfortunately, sacrifices have been made by primary care for a while now and there is little room to provide the kind of care our patients deserve on a lesser fee schedule.

Of note, while a FEDEX package can be tracked with our high tech tools, the reality of a modern human doesn't lend itself to such analogies. The successful systems touted by our President deserve their fair do, I presume; but it is foolish to assume that this over-riding coordination somehow cares for patients independent of the detail-oriented, time-consuming process that good primary care represents. To continue to disrespect the role of financial incentive in supporting our work ethic is disingenuous. How can we stay so late, answer so many calls, persevere through the administrative morass, and continue to finance the automated processes that siphon precious dollars in the name of "disease management" and "performance" standards?

What a great idea to protect me from lawsuits if I follow some third party guideline. Let's be really careful in introducing any of these initiatives that assume that doctoring has really become such a ignoble enterprise. Go after the speculators, but give us front-liners some protection against the absurdities that currently characterize the private insurance enterprise, drug financing, underregulated institutional growth, and the radiology roulette.

rabornmd said...

President Obama and his close cronies will not stop until we have an equality for all healthcare system. There will be less patient and physician choice except for the government elite. Saul Alinsky would be proud