One of the critiques directed at ACP (but also at other physician membership organizations, like the AMA) is that organized medicine didn't get "enough" out of health reform for the doctors. By "enough," they usually mean permanent repeal of the Medicare SGR cuts and caps on non-economic damages in malpractice awards.
To be clear, ACP fought (and will continue to battle) for more effective medical liability reforms, including caps, and a permanent end to the cycle of Medicare SGR payment cuts. There are good reasons why neither ended up in the final legislation, which I will come back to in a future blog.
Today, though, I want to address the broader issue being raised by asking what physicians "got" out of health reform. The implication is that ACP should have approached health care reform more like a labor union or trade association, entities that exist principally to protect and promote the economic interests of their members. They engage in "transactional politics" - that is, they approach legislation - from the standpoint of "what's in it for me?" And if they can't get a deal that gives "enough" to their members, they oppose it.
Five years ago, political strategist Joe Trippi blogged on how transactional politics is diminishing our democracy:
"Transactional politics. I'll give you a tax cut for your vote. Health care for everyone for your vote. I'll keep you safe for your vote. Everything is a transaction with the citizen in a transactional democracy - and both of our nation's political parties fell to transactional politics long ago. It happened so slowly. It's like your eyes adjusting so well to the dark and living in the dark for so long - that you don't realize that the bright light of our democracy has been diminished. Transactional politics breeds the politics of 'what's in it for me?' 'What do I get?' At the expense of the common good - something almost never mentioned by our nation's leaders - in both parties - over the past few decades."
Transactional politics may be the raison d'etre for unions and trade associations, but physician membership organizations like ACP are bound by a higher purpose, which is to pursue public policies to serve the broad interest of the public, not just the economic interest of their members. ACP's mission is "To enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine" and a principal goal is "To advocate responsible positions on individual health and on public policy relating to health care for the benefit of the public, our patients, the medical profession, and our members."
ACP also has endorsed the Charter on Professionalism, which was published in the Annals of Internal Medicine, APC's flagship journal. The Charter states that "the medical profession must promote justice in the health care system, including the fair distribution of health care resources" and "A commitment to equity entails the promotion of public health and preventive medicine, as well as public advocacy on the part of each physician, without concern for the self-interest of the physician or the profession." [emphasis added]
By this standard, then, ACP was bound to look at health care reform not exclusively out of "concern for the self-interest of the physician or the profession" but by how it would improve access for patients and the public.
This doesn't mean that ACP didn't pursue (and achieve) policies that had direct benefit to members, including increased Medicare and Medicaid payments to primary care internists (which, it believes, will also have benefit to the public). But ACP's advocacy put a premium on how the legislation would improve access to affordable health insurance coverage. Some recent comments on this blog have taken issue with this, with one writing "it is time for the ACP to change its name to American College of Patients - this suits its mission better than the current name."
I understand and respect the principled reasons why some ACP members believe that the legislation will not be to the benefit of the public. But I would hope that most ACP members wouldn't want ACP to act like a union or trade association that exists only to engage in the transactional politics of "what's in it for me?" The question that ACP asked itself throughout the legislative process was "Will health reform result in 'public policy relating to health care for the benefit of the public, our patients, the medical profession, and our members?'" In the end, it decided that it would, even though the final law didn't include everything it (and its members) wanted.
Today's questions: Do you think ACP should approach legislative advocacy like unions and trade associations that make decisions on legislation based on "what's in it for me?"