Opinion

Reflecting on successes and looking to future challenges

A message to all physicians about current events in medical practice

By Joseph M. Heyman, MDis an obstetrician-gynecologist in private practice in Amesbury, Mass. He served as chair of the AMA Board of Trustees during 2008-09. Posted March 9, 2009.

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The American Medical Association and its federation partners have had several advocacy successes since my good fortune to become your Board of Trustees chair last June.

They started with political fireworks over the July 4th weekend as we replaced a deep Medicare physician pay cut with a small increase.

Added to that were legal victories against hospital boards ignoring medical staff bylaws. We helped expose and replace a system in which insurers could deprive patients of their promised coverage -- and their physicians of their appropriate payment.

We finally succeeded in passing mental health parity. The Children's Health Insurance Program was extended through 2013, while avoiding the closure of physician-owned hospitals. We advocated successfully for the Higher Education Opportunity Act to help students better manage their loans. With the Pennsylvania Medical Society, the AMA was instrumental in blocking the proposed merger between Highmark Inc. and Independence Blue Cross. We successfully defended physicians' privacy in the Consumers' Checkbook/Center for the Study of Services suit for public disclosure of individual physician Medicare payment records.

And a few days ago, with the Arkansas Medical Society, we preserved patient choice and protected competition when an Arkansas court ruled that the state's largest hospital system inappropriately restricted hospital admitting privileges and interfered with the physician-patient relationship.

This is a new year, and late in February, President Obama sent a budget proposal to Congress that calls for a $634 billion "reserve fund" over the next decade to finance expanded health insurance coverage and other health care investments.

Of particular importance to physicians is the fact that the budget proposal includes nearly $330 billion "to account for additional expected Medicare physician payments" over the next 10 years. If adopted by Congress, this effectively would stop the steep scheduled Medicare physician payment cuts of 40% over the next seven years. In fact, the president's proposal for a realistic budget baseline for Medicare spending on physician services responds to a long-time advocacy goal shared by the AMA and other medical organizations.

As successful as we have been, the physician leaders of our generation have inherited a daunting challenge to the health system reform we need. But this challenge also is a chance to put aside small differences, and finally to address the complex issues and solve the problems that stand between us and a healthier country.

The clamor for change in American health care is louder than ever. We hear it not only from the Obama administration and the 111th Congress but also from business and employer groups, from organizations across the political spectrum and from patient advocacy groups.

Simply put, the current system is not working well for physicians or patients. As doctors, we have legal, ethical and moral obligations to treat the patients of this country. But our legislators -- who have similarly taken oaths to serve the nation -- must ensure the resources and environment for our health care system to thrive.

Our joint challenge now is how to sort out competing strategies yet still achieve our shared goals.

We physicians do not live in a vacuum. We welcome divergent views on priorities, strategies and tactics to achieve our mutual goals.

But there must be civil discourse. We cannot afford to adopt the inflammatory, destructive tone seen and heard in talk radio, cable news punditry and the Internet blogosphere. We are better than that. Reasonable people can disagree reasonably.

It also is essential that we avoid the absolutism that has marked the discussion in recent years. Health reform will be a process of negotiation. We have an opportunity to forge new partnerships and build on previous collaboration. I hope that ultimatums are a dying vestige.

Right or wrong, perceptions have been formed about the role of organized medicine in past reform efforts. Some government officials, members of the media and others believe that organized medicine has been an obstacle to reform. Still others perceive that physicians take an "all or nothing" stance, or at best a "Yes, but..." attitude that comes with a long list of qualifications.

Of course, we should oppose some proposals -- such as single-payer coverage -- and we will. But it is important that we offer credible alternatives, and we clearly define what the profession does support, so we can improve the system.

Yes, the legislative and political process often can be hard to follow. It is fluid and confusing, and can transmit mixed signals. But there are often many paths toward a desired outcome. Sometimes negotiations behind the scenes can achieve the result we want and foster relationships we will need later to realize other objectives.

Medicine should not become a captive of partisan battles in Congress or elsewhere. Our commitment must be to advance sound policies that enable physicians to serve patients better through high-quality, affordable care for all. Partnerships with other stakeholders will be critical to our success, whether they are patient groups, businesses or other health organizations. With a broader base of support, we will be able to leverage our resources to advance mutual goals.

Success can be achieved by pursuing a "win-win" strategy. That's what the Kellogg School of Management at Northwestern University teaches. They call it "Co-opetition"! The entire team is victorious. In complex societies, competing parties usually achieve a better outcome through cooperative efforts than by going it alone. Health care is no exception.

As the American educator William Arthur Ward said: "Leadership is based on inspiration, not domination; on cooperation, not intimidation."

There will always be bumps in the road. But at this critical time in history, we need to work as a team to achieve reform. Together we are stronger.

Joseph M. Heyman, MD is an obstetrician-gynecologist in private practice in Amesbury, Mass. He served as chair of the AMA Board of Trustees during 2008-09.

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