Politico and other media outlets are reporting that President Obama plans to make a major speech to communicate to the public what he wants from health care reform, and how it will benefit them. The change in approach recognizes that "we're in the eighth or ninth inning here, and so there's not a lot of time to waste" as David Alexrod, one of Obama's top strategists described the situation to Politico.
As the President re-evaluates his approach, it may be time for internists to also take a step back and consider what they want from health care reform.
If you asked me a few months ago, I would have told you that internists were generally in agreement that the current health care system needs major reform. Now, I am less sure. Like the American people as a whole, my sense is that more internists are having second thoughts about whether they really want health reform to happen. Some, of course, have already made up their minds.
This is somewhat surprising, since internists have long championed the need for health care reform. In fact, health reform was a cause celebre for ACP long before President Obama was elected.
More than fifteen years ago, ACP called for reforms to make health insurance universal and "portable" - not dependent on place of employment, residence, or health status. In the late 1990s, we published a landmark paper on the scientific research linking lack of insurance coverage to poorer outcome. The paper, titled "No Health Insurance? It's Enough to Make you Sick" found that uninsured Americans tend to live sicker and die earlier than insured Americans.
ACP developed its own proposal - released in 2002 and updated this past year - to provide coverage to all Americans with seven years. It calls for income-based tax credits to help people buy coverage, insurance market reforms, and group purchasing arrangements - not unlike the legislation being considered today by Congress. (Bills based on ACP's proposal were introduced on a bipartisan basis in the past three Congresses.)
In 2004, we published research on the costs of not providing coverage to all Americans, and in 2007, the Annals of Internal Medicine published a paper (disclosure: I was a co-author) comparing U.S. health care to other countries and drawing lessons from them. Notwithstanding the oft-stated argument in this political season that the U.S. has the "best health care in the world" we found that the U.S. lagged behind other countries on many measures of effective care and that most effective systems had certain common features - including coverage for everyone and a strong primary care physician workforce - even though they differed on how to provide coverage.
In April, 2009, the ACP Board of Regents adopted a statement on the organization's "desired future" for the health care in the United States, which says this:
"The U.S. health care delivery system provides access, best quality care and health insurance coverage for 100% of our citizens."
Not 80 or 90 percent of our citizens, but every American.
Today, we have a chance to achieve this desired future, or to at least put the steps in place to make it possible in the near-term future.
The question is: How many internists still want Congress to enact legislation to provide coverage to all our citizens? How many prefer that they fail?
I know and respect the fact that some ACP members have principled reasons for opposing elements of the bills being considered. They tell me that they are concerned about whether the country can afford to provide coverage to everyone, and believe there is too strong a role for government in the bills being considered. I also know and respect the fact that some internists, on the other side of the political spectrum, feel passionately that a single payer system is the only answer. Many internists also believe that the bills fall short - I am with you on this - on important issues like medical liability reform and support for primary care.
The current bills will be changed, and with the continued support of ACP members, we have an opportunity to get improvements in them.
But health care is at make-or-break point. Internists - like all the rest of us - will need to decide if they are willing to support the compromises needed to get legislation enacted into law that provides all our citizens with access to insurance coverage. Just as the president has to decide what compromises he is willing to offer and accept to achieve the same.
I also believe that if the current effort fails - and physicians will have a lot to do in deciding the outcome - we will be consigning tens of millions of Americans to a future with no health insurance coverage. And, as ACP said in 1999, that's enough to make you sick.
Today's question: At this critical decision point, do you think that most internists want Congress to succeed in passing legislation to provide just about everyone with access to affordable coverage?