I expected spirited commentary on ACP's position on the final health reform bill, including taking our fair share of lumps. Particularly at a time when emotions are running high, I think the debate needs to be informed by the factual and substantive reasons for ACP's posture.
ACP's website has a new two page summary, a more detailed section by section analysis of how the legislation compares with ACP policies, and responses to Frequently Asked Questions about the legislation.
Anyone who is willing to review the materials with an open mind should find that there is much in the legislation consistent with policies that have long been advocated by ACP's membership.
Our overall approach, as largely mirrored in the legislation itself, is hardly radical - it builds upon and improves the current private employer-based health insurance system, principally relying on tax credit subsidies for individuals and small businesses and group purchasing arrangements to expand coverage, and appropriate and needed regulation of the insurance industry to ensure that it does not engage in practices that help their bottom line by excluding persons with pre-existing conditions. There is no public option or new government run health plan. These are policies that ACP itself advocated at least as far back as 2002, and in some cases much longer, way before this President and Congress took office.
I challenge those of you with a dissenting view to identify the specific policies in the bill that ACP supports - and why you disagree with them? Do you disagree with providing advance refundable tax credits to help people and small businesses buy insurance? To group purchasing arrangements from small businesses and individuals? To giving small businesses, self-employed persons, and others without access to employer-sponsored coverage a wide choice of qualified health plans? To prohibiting insurance companies from turning down or overcharging people with pre-existing conditions? To providing coverage of evidence-based benefits with no cost-sharing? To increasing Medicare and Medicaid payments to primary care physicians? To increasing funding for the National Health Services Corps and Title VII programs? To closing the Medicare Part D doughnut hole? To funding wellness and prevention programs? To standardizing insurance company transactions to reduce administrative costs? To funding research on comparative effectiveness to inform clinical decision-making? To providing coverage, principally through private insurance, to 95% of legal residents in the United States?
On tort reform, yes, we would have liked for the legislation to do more. But caps on non-economic damages, which we continue to support, are not the only alternative to the current trial by jury lottery system. Even when the Republicans controlled the White House, the House of Representatives, and the Senate, they never got tort reform enacted into law. (Caps passed the House on several occasions, but never got a majority of GOP Senators.) I don't make this observation for a partisan reason, only to point out that Washington's inability to enact caps is a bipartisan legacy that both political parties share. Given the long-standing and continued impasse in Washington on caps, it makes sense to explore other solutions on a state level, like funding for health courts.
Some of you have questioned how ACP arrives at its policies. ACP has a very inclusive policy development process that involves review of all policies by our elected Board of Governors and our Council of Student Members, Council of Subspecialists, Council of Young Physicians, Council of Associates, and Council of Student Members, before they are voted on by the Board of Regents. The policies originate in policy committees that are made up of rank and file ACP members. Any ACP member can recommend to their state's chapter governor that a resolution be introduced into the ACP Board of Governors. The resolutions to be discussed at the April Board of Governors meetings are now available for comment by ACP members until April 1. Several of the resolutions are directly relevant to the positions ACP has taken on health reform.
And yes, we have surveyed the membership, although we do not believe surveys - which any researcher will tell you are at best snapshots of opinion at a given time - are a good way to establish policy. The 2009 Membership Survey asked members for their priorities on health reform. On page 96 of the survey, you'll see that there is very broad support among membership for ACP's support for universal coverage, with 70% agreeing that "Guaranteeing by law that all Americans have access to affordable coverage, with government subsidies for those who cannot afford coverage" should be a somewhat high or very high priority. In October through November 2009, a more detailed survey was fielded by ACP's Research Center that also showed strong support from membership for the key policies advocated by ACP - including support for many of the more controversial policies.
Finally, the notion that the volunteer physicians who have dedicated their time to positions of leadership in ACP are a disconnected "elite" is inaccurate and unfair. I know these people, and I have the greatest respect for them. Our current President, Joe Stubbs, is a general internist in small private practice in Albany, Georgia. Our President-elect, Fred Ralston, is in private practice in Fayetteville,Tennessee. The chair of our Medical Service Committee, Yul Ejnes, is in a private internal medicine practice in Cranston, Rhode Island. The chair of our Health and Public Policy Committee, Rich Neubauer, provides care to Alaskan Natives in Anchorage, Alaska. The chair of our Board of Regents, Fred Turton, hails from a long background as a private practice internist in Sarasota, Florida. Yes, we include ACP members who also are in academic practices, as we should - all voices in the ACP membership are represented. But by no means is the ACP leadership detached from the realities of private internal medicine practice, when private internal medicine practice is still the bread and butter of much of our current leadership.
I understand and respect that there is a philosophical and substantive basis for some to disagree with ACP's views. For over a year now, the country has debated such issues as how much the government should be involved in regulating and subsidizing health care. Like the broader public, some ACP members will conclude that the legislation gives the government too much of a role, some too little, and like Goldilocks, some will decide that it gets it just right. But the time has come for Congress to decide one way or another. I believe that ACP has arrived at a strong, factual, evidence-based, and balanced position that serves its members well, by championing improvements that will expand access and coverage to millions of patients in a fiscally responsible way.
Today's questions: (For those who disagree with ACP), what are the specific policies in the bill that ACP supports that you disagree with, and why? (For those who agree with ACP), which specific policies that ACP supports do you agree with, and why? For those who are still unsure, what policies do you think are most important for ACP to continue to advocate?