Health reform law is the first step to a better system

On March 23, AMA Immediate Past President Nancy Nielsen, MD, PhD, and I were privileged to be in the White House when President Obama signed the Patient Protection and Affordable Care Act. It was a historic moment marking the passage of the most sweeping health legislation this country has seen since the creation of Medicare in 1965, and I was proud to be there on behalf of the AMA.

Nevertheless, I recognized then -- and maintain today -- that while this bill represents a tremendous step forward on the path toward meaningful health care reform, it is certainly not the last step. This legislation is not an end. It is a beginning.

During the week prior to the House of Representatives vote on the health system reform bill, the AMA board engaged in the most important debate we have had in years. We knew that the bill before us was far from perfect, and that many of our physician members throughout the nation had legitimate concerns.

But we also recognized the significant progress it would make on many of the core principles the AMA had formally endorsed at its 2009 Annual and Interim Meetings. Moreover, we knew that it stood to benefit millions of Americans in need -- both insured and uninsured. In the end, we decided to issue our qualified support for the legislation. And perhaps the best way to explain that decision is by summarizing some of the provisions that became law on March 23.

Because of the health system reform package, 32 million uninsured Americans will gain access to coverage. In addition, competition and choice will be improved in the insurance marketplace, prevention and wellness initiatives will be promoted and administrative burdens will be reduced.

There also will be greater accountability and transparency for insurance companies, and clinical comparative effectiveness research will be promoted. Individuals who already have insurance no longer will have to worry about lifetime caps on coverage or policy cancellation, and children now can stay on their parents' policies until age 26.

With regard to medical liability, the legislation acknowledges that the current system is broken and provides funding to test reforms such as health courts and early disclosure laws. This may not be the comprehensive medical liability reform physicians and the AMA ultimately seek, but it is more than we have achieved on this critical issue in the past.

Yet despite these important gains, as I said, the health system reform package is far from perfect. There are significant provisions in the legislation that the AMA does not support, as well as some important measures that have been left out. In short, there is still much work to be done.

First, the legislation does not repeal the flawed Medicare sustainable growth rate formula. As we all know, this has been a burning issue for doctors, seniors and military families for years. The AMA continues to apply pressure to both Congress and the administration on this issue, and we will not relent until SGR is repealed permanently.

Second, the scope and authority of the Independent Payment Advisory Board must be addressed. The current framework outlined in the health system reform bill could result in misguided payment cuts that undermine access to care and destabilize health care delivery. The last thing doctors need is an additional flawed payment system -- on top of SGR.

In the coming weeks and months, the AMA will continue to advocate for these and other important changes. We also will work hard to help our members understand and respond to the implications of the new law on their practices.

To that end, we already have launched a new AMA Health System Reform Insight e-newsletter, which delivers the latest information and advice right to our members' inboxes. We also have made a wealth of resources available on our Web site, such as an implementation timeline and answers to members' frequently asked questions.

This long debate has been divisive from the start, and has taken a toll on our medical profession. But I think we all can benefit by stopping for a moment to reflect on the context -- on the realities that prompted this debate in the first place: 46 million uninsured Americans, insurance monopolies, $2.4 trillion in annual health care costs, and mountains of paperwork and administrative bureaucracy.

The problems we seek to address are significant and not easily resolved under any circumstance. But for the first time, we are making progress on legislation that achieves many of the policies our House of Delegates has been refining over the last decade. Ultimately, history will judge whether the decisions we made during this turbulent time were the right ones. But this much is already clear: They most assuredly were principled decisions. And while we wait for history to render its verdict, I promise you that the AMA will not rest. We will remain fully and actively engaged to secure optimal outcomes for physicians and the patients under our care.

I believe this is a defining moment for organized medicine and the AMA. And it is also a tremendous opportunity. Let's work together to bridge the legitimate differences that exist, but as we do, let's not lose sight of the more substantial common ground we share. There are many challenges yet to be addressed, and many areas in which we -- as physicians -- can best be served by allying together as a common voice. I humbly and respectfully ask for your help. Together we are stronger.