Opinion

Where does your candidate stand on medicine's issues?

A message to all physicians from AMA President Nancy H. Nielsen, MD, PhD

By Nancy H. Nielsen, MD, PhDis an internist from Buffalo, N.Y. She was AMA president during 2008-09. Posted Oct. 20, 2008.

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On Nov. 4, America's physicians and patients will enter the voting booth and help decide the course of our nation. The cynics undoubtedly will say that elections don't matter and that politicians -- and policies -- are all the same.

They are wrong.

Every physician should remember that our elected officials craft the policies we must abide by (and sometimes suffer through). It was our elected representatives who created Medicare and Medicaid, the Health Insurance Portability and Accountability Act, and the rules by which new pharmaceuticals are introduced into the marketplace -- and our offices.

In some states, our elected officials have been instrumental in enacting reasonable medical liability reforms. They have been champions supporting prompt-pay laws for managed care. And they have worked with organized medicine to help ensure patient safety by appropriately limiting nonphysician scope of practice.

At the federal level, the AMA is in close contact with Congress and the federal agencies. We're also in close contact with our grassroots network of physician and medical student leaders across the country. These close relationships enable us to work together -- to speak with one highly persuasive voice. Quite frankly, it was the deciding factor to help avert a Medicare meltdown earlier this year. And these relationships -- in Washington, D.C., and across the nation -- are what enable us to keep working toward a long-term Medicare solution.

We need our champions, but make no mistake, the issues facing medicine will still be present when the new president and Congress take office Jan. 20, 2009. Whichever candidate is elected, whichever party is in control of Congress, there are significant issues that must be faced. Consider:

  • Seventy-nine million Americans are having problems paying off crushing medical debt, a number that rose from 34% to 41% from 2005 to 2007.
  • Our nation spends 16 % of its gross domestic product on health care, but lags behind other countries on some health status indicators, and nearly 46 million Americans do not have health insurance coverage.
  • We won a reprieve from devastating Medicare cuts this year, but we face a 21% cut in January 2010 if Congress doesn't fix the broken un-sustainable growth rate that the government uses to calculate payments to physicians.

So when you go into the voting booth, I want you to consider how your candidates -- at the state and federal levels -- propose to address these issues.

  • Are your candidates committed to finding a workable solution to cover America's 45.7 million uninsured?
  • Do your candidates support eliminating Medicare's unsustainable SGR and protecting our nation's seniors' access to care?
  • Will your candidates work with the AMA to promote quality improvement through appropriate guidelines designed by physicians?
  • Can your candidates look you in the eye and say they will be champions for medical education and increasing resources for primary care?

This election, you can make a difference by making sure you know the answers to these questions.

While there is a tendency in politics to play "gotcha" and duel over the trivial, America's physicians and patients are looking for answers.

We understand that the issues facing medicine are complex. We understand they will not be solved overnight. But this election, we must look closely at who we empower to work on our issues in the future. We must demand action, progress and leadership. We must keep the focus on important health system reform issues.

And remember, physicians and their families also need to exercise their civic duties by voting for candidates who are committed to improving the health of all Americans.

The bottom line: Ask, "What are you going to do to help me help my patients?"

That is what I will be thinking when I step into my voting booth.

Nancy H. Nielsen, MD, PhD is an internist from Buffalo, N.Y. She was AMA president during 2008-09.

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