The natural tendency for most people, is to put off a difficult choice as long as possible. So instead of taking definitive positions on controversial issues, we sit on the fence.
Before too long, though, fence-sitting can be pretty darn uncomfortable. When the fence separates two warring parties, getting off requires that we make a decision on which side to join. Staying on the fence, though, guarantees that we'll get caught in the crossfire.
Release of the House's health care reform bill is forcing physicians to get off the fence. They are deciding if they want to be on the side that wants President Obama and Congress to succeed in getting health care reform enacted this year. Or, to join forces with those who want to stop them.
(Opponents of the current bills will say that they aren't against health care reform, just against how the Democratic majority and President Obama plan to go about it. Fair enough. But as a practical matter, the opponents don't have the votes to pass their alternatives - whether it is small government, market-based reform from the right, or a single payer system from the left. So if they are successful in getting Congress to defeat health care reform for this year, they likely will have killed health care reform for the remainder of Obama's presidency. Which, I suspect, is what most of the opponents really want, when all is said and done.)
Choosing sides is particularly hard when you represent a diverse membership like ACP's - or the American Medical Association's. We have liberals and conservatives and everything in between. We have generalists and subspecialists, city dwellers and country doctors, red-staters and blue-staters, solo doctors and doctors in mega-group practices. We have the glass-half-empty pessimists and the glass-half-full optimists. We have starry-eyed idealists and rock-ribbed cynics. I hear from them all.
It is also hard when you are a non-partisan organization, like ACP, knowing that any decision you make on supporting a bill that is being championed by one political party (in this case the Democrats) will be opposed by most members of the other political party (in this care, Republicans). We had the reverse a few years ago when ACP took its lumps from Democrats for supporting the Republican-championed Medicare Part D drug bill.
I think it is significant then, that the largest medical organizations in the United States, representing the most diverse memberships, have all decided to be supportive of the House bill. Letters of support have been sent by the American Medical Association, ACP, the American Academy of Family Physicians, American Academy of Pediatrics and the American Osteopathic Association. The American College of Surgeons is also expected to support the bill.
Why did these organizations, which collectively represent the vast majority of physicians in the United States, decide to get off the fence and take a stand in favor of the House bill? One explanation is that we all are suffering from mass insanity, as one commenter said about ACP in response to my post yesterday. If one assumes though that we haven't all lost our collective minds, then I would hope that the critics of our positions would consider our reasons for support, and offer a considered rejoinder if they disagree.
For ACP, the reasons for our support are pretty clear: the bill does much of what we asked Congress to do in terms of coverage, support for the primary care workforce, payment and delivery system reform, based on long-standing policies that have been adopted by this organization. We would support any bill that accomplishes our goals in a way that is consistent with ACP policy, whether championed by Republicans or Democrats, but prefer when they are supported by both. (This, regrettably, is rarely the case these days.) Most importantly, we believe that the status quo is not in the best interests of doctors or patients, and that the risk of staying with the status quo is greater than the risk of change.
This doesn't mean we are fully satisfied with the bill. We will, for instance, continue to seek more meaningful improvements in pay for primary care and push our ideas on how a public plan should operate. But we have to stay at the table if we want to make such improvements, because the game will go with or without us.
Today's questions: Do you think it is possible for large and diverse physician membership organizations, like ACP and AMA, to keep their membership (mostly) together on issues as controversial as health reform? If so, how?