Tuesday, April 27, 2010

Guess what? Most aren't angry about health reform

I just got back from a wonderful week in Toronto, Canada. No, I wasn't up there to take tips on how to impose socialized medicine on an unsuspecting public, notwithstanding what some of you may incorrectly-surmise about my political leanings. Rather, I was there to attend ACP's annual scientific meeting, during which I had the opportunity to serve as faculty for three separate scientific sessions that discussed the impact of the new Patient Protection and Affordable Care Act (PPACPA) of 2010 on internists and their patients. Several hundred ACP members attended these sessions.

And guess what? Rather than encountering doctors who were angry at the new law and ACP's support for it, I instead found an engaged and curious group of internists who are looking at health reform in a reasoned, measured and open-minded way.

I would characterize the prevailing mood as hope and uncertainty, not anger and discontent:

Hope that the law will improve access to affordable coverage and provide much-needed support to primary care.

Uncertainty about whether it would pay for itself or solve the primary crisis.

Several expressed disappointment that it didn’t do more to reform the tort system or get rid of the Medicare SGR formula. Yet only one member came to the microphone to accuse ACP of "selling out" internists, and he was vastly out-numbered by the many dozens who expressed appreciation for ACP advocacy. Most said that they are looking to ACP to be the trusted source of information on what the new law means.

Internists aren't alone in viewing the new law without rancor. An April Kaiser Family Foundation tracking poll finds that although the public remains divided on the legislation, only 30% are "angry" about it compared to the 69% who said they are "not angry." The poll also shows that the 56% felt that they did not have enough information on how it will affect them personally, compared to 43% who said they had enough. 55% said they were confused compared to the 45% who weren't. Yet many of the specific policies in the law were supported by large (bipartisan) majorities.

Most also said they got most of the information about the law from cable television, but when it comes to getting information they can trust, they look to doctors, writes Mark Blumenthal in the National Journal online. "For all their cynicism about government and the news media, when it comes to health reform, most Americans trust their doctors" more than anyone else. He cites a recent Gallup poll: 77% expressed confidence in doctors recommending the right thing for health reform, compared to 49% for President Obama, 37% for Democratic leaders in Congress, 32% for GOP congressional leaders, and 26% for health insurance companies. Blumenthal continues,

"Many of the doctors are as confused about the new law as their patients. 'Quite honestly,' one doctor told the Times, 'I don't know how to answer their concerns.' So maybe I should bump up my advice [the Obama administration] to two words:

Doctors. Stat."

This brings me back to why I was so heartened (but not at all surprised) by the measured views expressed by the internists at ACP's meeting. They understood that their patients are looking to them for advice and help, and they in turn are looking to ACP to help them understand and explain the law to their patients. They came to learn about the health reform law, not to throw bricks at it.

Today's questions: Do you think the country is ready to move beyond anger and rancor, to a measured discussion of what the new health reform really means for patients? Do you think physicians can and should lead this conversation? How can ACP help?


Steve Lucas said...

From a very technical standpoint it must be remembered that the physicians attending this conference had to make an international trip to support the organization. I would also guess they were financially secure in order to afford the conference fees.

While I think the first wave of anger over health care reform has passed, I feel that there is still a great deal of animosity over the current legislation. We are seeing almost daily reports about how cost will rise and other government programs, including Medicare, will need to be cut in order to dig ourselves out of the budget hole we seem to be drilling.

The ACP’s role should be neutral, supplying doctors with information. Introducing bias of any type will only push the ACP into one camp, or the other, thus negating its impact on the discussion.

Steve Lucas

Arvind said...

In addition to what Steve noted, it should also be noted that you approached this meeting with your own bias favoring this law. Besides, those ACP members that do not agree with the ACP's position are generally frustrated with the organization, so chose not to attend this meeting in Toronto. Those that did attend were probably mostly the academic types, who have no clue as to how to operate a successful private practice.

The ACP should try and balance its views between what it considers a moral position and what is considered a practical one. Ten years from now, when some in the ACP will be publishing documents as to why they failed their physician-members, they will have some solace to take that they tried to balance their views in 2010.

Harrison said...

I went to Toronto. I was at the one session where a physician was first to the mic and implied that the ACP had given support to the health care reform bill too heartily without asking for enough in return. He was not angry. He made points and Mr. Doherty's response was appropriate. And factual.

I went to give a talk at a community center about a week before the meeting in Toronto. It was with a group who were signing up for a Medicare Advantage plan. My role, as someone who is new in the area and who is a new member of a small single specialty general internal medicine group, was to discuss how to make the most out of a physician visit, and to talk about what to expect from physicians during a visit.
I was asked to comment on health care reform, and the new bill.
This blog helped me field that question, and not be negative.
It doesn't pay to be negative.
The Medicare Advantage product that hosted the meeting had a rep who chimed in. The product is owned by United Health Care, and the rep was not opposed to the bill, and pointed out that United Health Care did not plan to cut benefits to patients -- and instead would absorb losses.
I'm guessing that they have positioned themselves for this eventuality, and anticipated needing to compete and also trim their product to be profitable.

I look to the ACP for information.
This blog has been helpful.
The comments by those critical of the ACP positions as outlined in this blog have been just as helpful to me.

I have a meeting with a community group of seniors again today.

Back to my day job.