Clout: The force of 819,000 voices in Washington

A message to all physicians from AMA President John C. Nelson, MD, MPH.

By John C. Nelson MD, MPH amednews correspondent— Posted April 18, 2005.

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Senate Majority Leader Bill Frist, MD (R, Tenn.), spoke to the AMA's National Advocacy Conference last month in Washington, D.C. He noted that the number of physicians in the U.S. Senate had just doubled -- to two. He then alluded to the 58 senators with legal backgrounds.

He could have added 160 lawyers among the 315 members of the House.

That box score summarizes our challenge in being heard in the great national dialogue on matters of medicine. Two U.S. senators and 10 representatives understand intimately what we face in dealing with the issues that plague the other 819,000 of us who practice medicine in America.

But what about the other 98 senators and 305 representatives?

Obviously, our mutual efforts through AMA advocacy programs must be having an effect, because everyone we heard from in official Washington echoed the same refrain: When the AMA speaks, they hear what we think about medical liability reform, physician payment systems and other issues.

Critical role in the future

Dr. Frist, Dept. of Health and Human Services Secretary Michael Leavitt, and Centers for Medicare & Medicaid Services Administrator Mark McClellan, MD, PhD, repeatedly cited the need for our support to expedite needed changes in the U.S. health care system.

Leavitt, noting that demographics is destiny, admitted a doubling of the Medicare-age population in 10 years will put enormous strains on the system, and more -- not fewer -- physicians will be needed.

Physicians, he said, are the critical element in making patients aware, informed and tuned in to the needs and resources to help them. And he asked our help in righting the wrongs of the medical liability crisis -- so that patients who deserve compensation receive it without losing access to care in the future.

Dr. Frist was equally firm in expressing his belief that true reform is impossible without physician participation. His "prescription for American health care" calls on us to help contain costs, increase information resources for our patients, end lawsuit abuse, expand health savings accounts and strengthen the safety net so that no American goes without some sort of health care insurance coverage.

Dr. McClellan sounded a familiar theme, one repeated by the other officials, when he said, "America's physicians are essential for the success of any of our efforts here in Washington to improve our nation's health programs."

Medical liability and SGR problems

Focusing specifically on the Medicare sustainable growth rate, he said, "Physician leadership is the best hope for a solution to Medicare's financing problems. And that means we need an effective, lasting solution to the physician payment problem.

"The SGR debate incorrectly frames physicians as part of the problem in Medicare. An effective payment system in Medicare would recognize that physicians are the most essential part of the solution."

Essential, too, is our role in advocating for medical liability reform. All three speakers alluded to the critical role we are playing in maintaining a drumbeat of popular calls for reform.

While that sentiment seems sensible to those of us in the profession, it may surprise our critics, and those who would derail our efforts and compromise the integrity of the patient-physician relationship.

Drs. Frist and McClellan know firsthand the multiple and critical roles physicians play. Secretary Leavitt has seen firsthand as a patient, the husband of a patient, the father of patients and, soon, the grandfather of patients, the miracles of healing the art and science of medicine bring to every patient.

Patient-centric efforts

It is humbling to be reminded by these three leaders just how important physicians are in the scheme of things and how they, among many other opinion leaders, recognize that our concerns and our commitment are not for us or our Association.

Our concerns and commitment are for our patients. But it is equally daunting to consider the challenges we face in ensuring access to quality care for all Americans -- despite medical liability system flaws, despite massive uninsurance, despite the insidious disparities that continue to diminish the full effectiveness of care.

Again, our concerns and commitment are for our patients.

Our AMA is focused like a laser on patient advocacy. We rely, not on top-down solutions from Washington, but grassroots-level-up advocacy that persuades lawmakers and regulators at every level of government.

I came away from Washington with two convictions:

  • First, that the men and women working to improve our nation's health care programs are sincere, dedicated and realistic in their understanding of our roles.
  • Second, that our grassroots efforts are having an effect. Each of us is appreciated and welcomed in the ongoing dialogues about improving care and better serving our patients.

Those convictions took shape in my mind as I listened to two icons of American political influence -- Republican Mary Matalin and Democrat James Carville -- open the conference with observations from across the political spectrum. From both the right and left came repeated references to the centrality of health care concerns, the need for constructive reform, and the power and influence of the AMA.

That the AMA is the most influential advocate for health care in America, as testified to by Secretary Leavitt and Drs. Frist and McClellan, is just one more reason you should join. It's as easy as calling 800-AMA-3211. You can help make our voice even louder and more credible. Because together, we are stronger.

And that's why I am proud to be a member of the AMA.

John C. Nelson MD, MPH amednews correspondent—

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