Medicine's voice being heard on health system reform

As our country hurtles toward health system reform, Medicine has been at the table during the discussions. The American Medical Association and the specialty and state society leaders have had access to and have been engaged with the White House and the key committees in Congress.

We have been working closely with top Obama administration officials and key staff members of both parties. We have given our best advice, and we have taken the time and effort to carefully consider all views. In truth, we're not just at the table; we're helping set the stage for our nation's future.

But as Sen. Jay Rockefeller (D, W.V.) said recently, "There's too much happy talk. It's time to start thrashing out decisions on the tough issues."

We couldn't agree more, which is why we need to keep focused on precisely what the issues are that are driving the current debate.

The first is cost. Our nation spends more than $2 trillion per year on health care, and there is nothing in today's health system to stop costs from increasing beyond our nation's ability to pay for it.

In fact, everywhere you look you can see the cracks: 46 million uninsured; millions more underinsured; patients putting off preventive care and buying needed prescriptions to save money for things like rent and food. If we all don't control costs, our nation is in deep trouble.

Physicians can't and shouldn't be held responsible for all medical costs, obviously. But we order and are involved in many of the costs, way beyond our own services. We deserve to be paid fairly for our services.

We also have a professional responsibility to be just stewards of finite resources. We have to be concerned about what works better than something else, about what costs more (for our individual patients and our country) than something else, and about honoring the wishes of our patients while giving them information on which to base informed choices.

We also have a right to point out the administrative costs we physicians have had to bear in this fragmented health care "system."

The second issue driving debate is quality. We've taken a leadership role on quality throughout the history of this association, not just recently. But recent history is instructive.

In our convening of the Physician Consortium for Performance Improvement, our work at the national Quality Forum, the AQA and the Hospital Quality Alliance, and in myriad other ways, we have demonstrated our commitment to the highest quality care for our patients.

We've worked collaboratively with specialty societies, employers and consumers to identify gaps in care and plug those gaps. Specialty societies are working through the PCPI right now to identify areas of misuse, outcomes measures and measures that are appropriate for teams of health care professionals.

And we've first asked, then demanded, the information and resources we need to deliver the best possible care -- at the point of care. We've demanded that "performance measures" (a term I dislike) be based first on quality, not just on cost. And we've won major victories over insurers who tried to portray cost containment as "quality."

The third issue is value -- a reflection of cost and quality, but also a term that must recognize individual needs and preferences.

For example, when I was a young mother with five small and healthy children, "value" would probably have meant affordable preventive care with coverage for emergencies. It meant something very different after my 7-year-old son had a stroke and needed rehab to regain speech and ambulation.

I have fortunately never had a malignancy, but if I had, "value" would have meant access to the best therapy and the best doctors who specialize in that field.

But there is another side to "value," which is what patients want and need and feel they don't get in the current health care system. That's a physician who knows them, really knows them, and cares about them as individuals. One who takes the time to understand their unique circumstances, beliefs and needs.

In days gone by, when the physician brought comfort and caring, there was often little else available to bring to the bedside.

Now, of course, we have life-saving and disease-altering therapies. But we all decry the lack of time with our patients. Physicians of all specialties feel pushed and are drowning in demands.

We value time with patients -- that's why we went into medicine in the first place. Even those specialists who don't have direct patient contact need time to read charts or consult with colleagues so the best diagnoses are reached.

And so many, many things have invaded that time and eroded the doctor-patient relationship.

We need to try to strip out those things that don't contribute to giving the best care to patients and demand administrative simplification from insurers and the government. We need to insist that "hoops" to jump through be minimized, and that they be used only when needed for patient safety and appropriate patient care.

In the past year, we've made good on many of our long-standing commitments to back America's physicians and patients.

We've won victories against many health insurance plans -- ending their use of rigged databases that (mis)calculated what was "reasonable and customary." We've won victories in court for hospital medical staffs. And we've won in Congress on issues ranging from stopping the Medicare physician payment cuts to Children's Health Insurance Program reauthorization to Food and Drug Administration regulation of tobacco. We've won a lot of important victories.

But, like previous AMA presidents, I have to report that we still lack widespread meaningful medical liability reform. We still need antitrust relief so we can negotiate with health plans, obtain important data and share in economic rewards from savings we accomplish. We still require the ability to contract privately with our patients without penalty.

I assure you, we are working on all those fronts.

In my year as your president, it's been gratifying to see that the AMA has garnered deep respect from all sides involved in health system reform because we've entered the health reform dialogue focused on our core values and our willingness to collaborate.

We've won victories because we've worked with new allies as well as longtime supporters. But don't mistake a willingness to work with all players with weakness. It's quite the contrary.

The next few months are likely going to be increasingly partisan and filled with rhetoric. Our profession must rise above all of that.

We will provide guidance and support that is meaningful as we seek to "help doctors help patients," reduce costs where we can, increase quality and enhance the value of health care for all Americans.

We need to demonstrate that our commitment to professionalism has not wavered.

We must ensure that our decisions, whether in the community clinic or at the negotiating table with Congress, uphold the foundation of our profession and allow physicians to finding meaning in the work they do.

Thanks for the privilege of serving you. It has been a tremendous joy and the highest honor of my career.