Clear thinking critical to solving Medicare pay problem

A message to all AMA members from the chair of the AMA Board of Trustees, Cecil B. Wilson, MD.

By Cecil B. Wilson, MDis an internist in private practice in Winter Park, Fla. He served as chair of the AMA Board of Trustees during 2006-07 and was AMA president during 2010-11. Posted Nov. 6, 2006.

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For the last several months, I have been sharing thoughts on various principles that guide us in our profession and in the American Medical Association. This has included the principles of unity, integrity, partnership and values.

It occurs to me that a common thread tying these principles together and important to guiding our actions is the principle of clear thinking.

Ours is a profession demanding the highest level of clarity of thought. From premed through residency and beyond, we are taught to think straight, think from an evidence base, think about our ethics and think of the importance of our patients' needs. We understand the importance of facing unpleasant truths, dispassionately analyzing data into information, information into knowledge, and ultimately, knowledge into wisdom.

Being wedded to the belief in the importance of clear thinking leads to some frustration and confusion when we face a culture that increasingly prizes emotion over thoughtfulness, irrationality over reason and shallowness over depth of consideration.

The evidence is everywhere, but especially in our nation's capitol.

In recent weeks, I have had the privilege of testifying before Congress, talking with the media, keynoting meetings and attending many others. Each of these experiences brought home to me the prevalence in the minds of our critics and our detractors of a good deal of muddled thinking.

For example:

  • Congress plans to cut physicians' Medicare payments 5.1% on Jan. 2, 2007, at the very time inflation increases the costs of providing care.
  • Census Bureau data clearly show that the numbers of Medicare recipients increase monthly, yet Congress chastises physicians when the number of services provided increase apace.
  • Congress routinely increases payments to hospitals, nursing homes and home health agencies serving Medicare patients but cuts physician payments.

Our stance has been straightforward. Cut payments, and access to physicians by our seniors will suffer. Simple economics demonstrates that supply and demand seek equilibrium around a fair price. Price controls create shortages.

Our critics claim that we are only interested in our own well-being.

No clear thinking there. Our interest lies in our patients' needs -- regardless of age or income or race or any other category.

Other critics claim that we are motivated only by politics. No clear thinking there, either. Our motivation is in our ethics, our code of conduct, our oath.

Some would say we should abandon our logic and common-sense approaches and become more emotional and rousing, more excited and demonstrative. I demur. Passion is needed. Passion guided by reason is more likely to succeed.

In the balance between passion and reason, what we need now is more reason and greater clarity of thought.

With this in mind, we should trust in the traditional American horse sense, letting facts and evidence rather than wishful thinking guide our actions. That is what makes a democracy work. The pilgrims whose courage and resourcefulness we celebrate this month were, if nothing else, role models for clear thinking, men and women of calm deliberation and rock-solid judgment.

They clearly saw the end-game of religious persecution they faced in Europe. They also recognized the need for hard work, perseverance and common effort in facing and, later, in taming a wilderness.

We are well-advised to model ourselves on such men and women.

And I submit that, once our thoughts are clear, intellectual honesty requires us to act. The alternative is the slow torture of watching irrationality in the saddle and muddled thinking swaying the public mind.

Henry Ford put in a few words the importance of clear thinking when he said, "Think you can, think you can't. Either way, you're right."

Cecil B. Wilson, MD is an internist in private practice in Winter Park, Fla. He served as chair of the AMA Board of Trustees during 2006-07 and was AMA president during 2010-11.

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