Opinion

Reform needs a more rational insurance purchasing system

A message to all physicians from AMA President J. James Rohack, MD.

By J. James Rohack, MDis senior staff cardiologist at the Scott & White Clinic in Temple, Texas. He was AMA president during 2009-10 and served as chair of the AMA Board of Trustees during 2004-05. Posted July 20, 2009.

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

When a species is threatened, the survivors are not necessarily the strongest or largest or the most intelligent -- but the most adaptable. This lesson from Charles Darwin is one to contemplate as the discussion on health system reform moves toward action on reform.

The American Medical Association is committed to our mission of preserving the art and science of medicine and the betterment of public health.

Our vision to help doctors help patients guides us as an organization. And in the ongoing debates in public forums, on the airwaves, in cyberspace and in the halls of Congress and the White House, we will follow the principles that our House of Delegates passed June 16, 2009, to evaluate any health reform change.

What must evolve is a plan that includes universal access to affordable, quality health insurance coverage through a mix of private- and public-sector options that preserve the freedom of choice for patients and practice for physicians.

In the sixth century B.C., Sun Tzu in the Art of War noted: Weigh the situation carefully before making a move. Victory belongs to the one who can master the stratagem of the crooked and the straight.

Since becoming your AMA president, I've seen firsthand how the media and political interests manipulate communication to confuse issues. That is why it is important to keep our eyes on the prize. Our goal is affordable, portable, quality health insurance coverage for all Americans that preserves choice and freedoms. So how do we evolve in America to achieve that goal?

While many want to change how medical care is paid for, the fundamental truth is that there are only three ways to pay for health care: The individual pays completely for all of his or her care; the individual pools money with others; or the individual receives charity from others. We know that this last path leads an individual to live sicker and die younger. For the wealthiest nation in the world to continue down that path of disparity is unacceptable.

The first path, where an individual foots the bill for all medical care, would result in a system that only about 1% of Americans could afford, especially in the event of catastrophic illness. Thus, pooling of money becomes the mechanism for the vast majority of Americans to obtain health insurance coverage.

For that reason, our AMA over the last three years has invested more than $15 million in our Voice for the Uninsured campaign to shine a spotlight on the plight of those without coverage and to educate the public about the AMA's solution.

We propose that individuals own their own insurance policies, purchased with the aid of advanceable tax credits that are inversely related to the individual's income. This approach is now part of the active discussion on how change will occur in American health care.

Our AMA policy supports a pluralistic system with both the private and public sector involved in the pooling. For it to succeed, we need an evolution in both.

Administrative waste is commonplace and needs to be stopped.

Simple fixes such as a common claim form for all private and public health payers would be an important start. As would easy-to-read-and-understand evidence of coverage, similar among all payers, to allow patients to know what their financial responsibility might be before the treatment starts.

Establishing a unified process to get needed care for patients when new technologies or therapies approved by the Food and Drug Administration enter common medical care would trim delays that harm patients.

In the United States, we know we have a long way to go to make medical care part of a system of care. We've seen examples where systems linking physician, hospital and payers have developed, such as Kaiser Permanente in California; Geisinger Health System in Pennsylvania; Grand Junction in Colorado; and Scott & White in Texas, but those are the exceptions, not the rule.

Health information technology will be the tool to enable these links to provide the real-time communication and information that will allow physicians to have a higher quality interaction with their patients.

Our AMA announced in June an information technology platform powered by Covisint that will link with Microsoft Health Vault. The platform will help practices evolve toward better interaction between physician and patient through the sharing of medical information instantaneously. Among the benefits would be fewer costly hospitalizations caused by negative drug interactions.

As American health care evolves over the next months and years, the political process in Washington will inevitably continue to spill into our medical profession.

So it is useful to remember the words of the spiritual father of American medicine, Sir William Osler, who noted this in his 1875 valedictory address at McGill University: "The great opprobrium of our Profession ... is the constant rivalry and distrust of one another displayed by its members. That men whose high calling ought to bind them closely together, and whose interests are so much in common, should thus disagree, is a matter deeply to be regretted, and, I would urge upon you ... to do all that may lie in your power to remove this scandal from our midst."

How we say it 135 years later is simple: Together, we are stronger.

J. James Rohack, MD is senior staff cardiologist at the Scott & White Clinic in Temple, Texas. He was AMA president during 2009-10 and served as chair of the AMA Board of Trustees during 2004-05.

Back to top


RELATED CONTENT

ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn