Tuesday, March 1, 2011

What does Obama’s speech to the governors, professional ethics in Wisconsin, and consumer health education have in common?

They are examples of how the American College of Physicians has taken leadership roles in influencing health policy to the betterment of patients and their physicians.

Within the last 48 hours, ACP has:

- Reminded physicians that professional ethics does not allow for them to sign off on false “sick notes” to excuse patients to engage in political advocacy or other purposes. ACP referenced reports from Wisconsin that physicians have been signing off on false sick notes to excuse public employees so that they could participate in the demonstrations, and emphasized that there is “universal ethics principle” at stake. “Honesty is a core professional obligation and lying, even for a patient, is a breach of that obligation," J. Fred Ralston Jr., MD, FACP, president of the American College of Physicians (ACP) reminded all physicians, including the organization's 130,000 internal medicine physician and medical student members. (ACP has not taken any position on the Wisconsin dispute over collective bargaining by public employees.) In the same spirit, I also encourage you to read DB’s Medical Rants posting on the same.

- Applauded President Obama for supporting a bipartisan bill, the Empowering States to Innovate Act, to give states more flexibility, earlier than now allowed by the Affordable Care Act, to design their own programs to cover their residents. The bill, introduced by Senators Scott Brown (R-MA), Ron Wyden (D-OR), and Mary Landrieu (D- LA), would advance by three years a provision in the ACA to exempt states from many of the ACA’s mandates if they can come up with their own programs to provide comparable levels of coverage to as many people without adding to the deficit. ACP’s statement noted that President Obama was embracing an idea advocated by ACP in its January 27 State of the Nation’s Health Care report. I first blogged about the Empowering Patients to Innovate bill back in November of 2010, when I referenced Ezra Klein’s blog post that argued that the proposal could point the way forward to bipartisan agreement on health reform by allowing states to “compete and succeed” rather than “repeal and replace.” It is good to see President Obama get on board with the idea, but will any Republicans (other than Senator Brown) take him up on it???

- Joined with a coalition of respected health organizations to announce the launch of a new website, www.healthcareandyou.org, to educate consumers about the Affordable Care Act and how it could affect them. The website explains that “the Health Care and You Coalition is made up of some of our country’s leading organizations that represent consumers, patients, physicians, nurses, hospitals and pharmacists. Our goal is to provide the public with easy-to-understand information about the health care law. HealthCareandYou.org is a place where individuals, families, small business owners and health care professionals can turn for help in understanding the law and how it impacts them.” In addition to ACP, the coalition partners are the American Medical Association, American Nurses Association, American Academy of Family Physicians, Catholic Health Association, National Community Pharmacists Association, the Cancer Action Network-American Cancer Society, and AARP. The latest Kaiser Family Foundation tracking poll shows how much confusion there continues to be about the law and why truthful and understandable information from trusted sources—the goal of the Health Care and You coalition—is critically important. The poll showed that one out of five Americans believe incorrectly that the Affordable Care Act and has been repealed and another 26% aren’t sure.

Advocacy for universal ethics principles that places honesty above all else, including lying on behalf of patient. Preserving the Affordable Care Act--while seeking bipartisan support to make it better-by giving states more options, sooner. Educating and informing consumers about the law. These activities, individually and together, help deliver on ACP’s mission to “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.”

Today’s question: What do you think about ACP’s activities on the ethics of false sick notes, support for a bipartisan bill to give states more coverage options, and the new http://www.healthcareandyou.org/ consumer website?


doc777 said...

Random chance would predict that the ACP would eventually get something right. Their position on the physicians writing “sick notes” for the teachers protesting in Wisconsin reassures me that our leadership has not completely lost touch with its rank and file members. These physicians were committing fraud and should be dealt with appropriately by the state Medical Examining Board. Even more disturbing was that these physicians were faculty at the University of Wisconsin School of Medicine and Public Health. Unfortunately, I suspect these physicians will get nothing more than a slap on the hand.

Ok, now back to the ACP we all know and love. To start with, calling Senator Brown a Republican is a stretch, at best. On the surface, the Empowering States to Innovate Act sounds like a good idea, but as usual, the devil is in the details. Stuart Butler’s commentary in the NEJM summed up the problems with this bill. Sure, the states can try their own approach to health care reform but only if multiple criteria are met. Butler states, “…it still locks the states into guaranteeing a generous and costly level of benefits. True, a state could propose alternative benefit requirements if they had the same actuarial value as those in the ACA. But the requirements go well beyond basic coverage, and the HHS secretary is the one who defines ’at least as comprehensive’ benefits.” If President Obama gets re-elected in 2012, it is extremely unlikely that any states would be granted waivers to implement plans deviating significantly from the administration’s view for how health care should look in this country. On the other hand, if a Republican is elected, states hoping to move toward a single-payer plan would likely be stopped in their tracks. Further, there is no mechanism in this bill to allow states waivers to integrate current Medicaid and SCHIP programs into their plan.

As for the new website, it certainly is consistent with the leadership’s “all in” approach to the ACA. A much more refreshing concept would be to start a website that explains how the ACA achieves all these “pie-in-sky” goals. An explanation of the Medicare cuts, the new taxes, the mandates, the real effect on our nation‘s debt, the unintended consequences, etc. would be a truly valuable resource for those wanting to know more about the ACA. Finally, before you conclude that the people believing the ACA has been repealed are wrong, you may want to wait for Judge Vinson’s clarification later this week. At least for the 26 states that are part of the Florida law suit, the ACA may well be definitively dead within days, at least until an appellate or the Supreme court revives it.

Jay Larson MD said...

Like the website

Harrison said...

I think the ACP position on false statements by physicians is a good position.
I think it is fine for physicians to show support for the protesters in WI, but a signed statement suggesting an illness in someone that the doctor doesn't know is not okay.

The website is very good.

And President Obama's concession was good, although it won't go anywhere.
It is not the compromise being sought.
The stated objective of the Congressional Republicans is the defeat of Barack Obama in the next election.
They will agree to nothing that allows him to look like he has helped the country.
He would have to sign a statement of regret for having been elected.

I agree though that he is giving the states little room to move.
But he is asking for a compromise from the conservatives.
He sees two problems with our health care system -- access and escalating costs.
The market left to be a free market may correct the cost problem.
But it would worsen the access problem.
If the access problem is not addressed, then we are abandoning our most vulnerable members of society. We are too wealthy as a country to do that.
And so the states must control costs and expand access.
The Congressional Republicans know that the only way to do that is with an even more radically left proposal -- a single payer system.
And so there will be no compromise.


David Ritchson said...

Good read from Obama. I wish he can focus more on medicare.