A prescription for America's health care system

A message to all physicians from AMA President Cecil B. Wilson, MD.

By Cecil B. Wilson, MDis an internist in private practice in Winter Park, Fla. He served as chair of the AMA Board of Trustees during 2006-07 and was AMA president during 2010-11. Posted June 28, 2010.

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When I was growing up in south Georgia, the son of an itinerant Methodist minister, my father would tell my brothers and me: "Remember, you represent the whole family. Act accordingly."

That simple statement of purpose has guided me through college, medical school, my service in the U.S. Navy as a flight surgeon, and my professional career and personal life in Florida.

It will continue to guide me as I begin my year as president of the American Medical Association.

I will remember that I represent the family of medicine -- and I will act accordingly.

As physicians, we have the opportunity to heal and the responsibility to do no harm.

And at this historic time, we have the opportunity to assure that our country's health care system bears the imprimatur of physicians, and we have the responsibility to bring to that task a voice that is clear, firm and constructive.

Last year, the AMA was part of the national debate over health system reform. As a constructive participant, the AMA was able to influence some of the direction and substance of the health reform law that emerged from a complex, imperfect legislative process.

In talking with AMA members around the country, I found that most physicians did not dispute the core principles of reform. Rather, it was on the interpretation of those principles -- and the strategy and tactics used to advance them -- that physicians disagreed.

To me, these reform measures are a long overdue first step -- a first step toward a better health care system in this country.

It makes medical care more accessible and coverage more reliable for millions. It makes insurance companies more accountable. It strengthens wellness and prevention.

I know that there are fences to mend, assurances to make and wounds to heal. And I plan to be a part of that effort.

That said, however, our energies going forward will be better spent doing the hard work of making health system reform the best it can be for physicians and patients. Now more than ever, we need to focus on what's best for our profession and our patients -- and act accordingly.

We all can do better -- government officials to insurers to patients.

And that's why, in my inaugural address, I offered some prescriptions for our ailing health care system.

The focus was on the challenges toward making health system reform a success. A few examples are medical liability, skyrocketing costs and Medicare underpayment.

Studies tell us that today 75% of American physicians are forced to practice defensive medicine -- to order tests or procedures more out of a need to protect against possible litigation than to improve patient care.

The health system reform legislation acknowledges this problem, but it does not go far enough to solve it.

Ultimately, placing caps on noneconomic damages is the gold standard for successful medical liability reform. Caps have worked for more than a generation in California, and they also are working today in Texas, Louisiana and other states.

My prescription: Caps. Caps are the only prescription proven to work.

We also need to explore alternative reforms, such as health courts, administrative compensation systems, early-offer models and "safe harbors" for those physicians who follow best practices.

Next, cost.

If nothing changes, by 2020 America will spend $4.4 trillion a year on health care. That means a family of four with an annual income of $80,000 would spend a fourth of that on health care. That's not sustainable.

My prescription: A comprehensive plan for containing costs and getting the most out of our health care dollars.

The AMA has identified four broad strategies to do this:

  • Reduce the burden of preventable disease.
  • Make the delivery of care more efficient.
  • Reduce nonclinical costs that don't contribute to patient care.
  • Promote value-based decision-making -- at all levels.

Another challenge is all too familiar -- the Medicare reimbursement crisis.

Because of the senseless payment formula, the sustainable growth rate, physicians are threatened with cuts. Year after year.

And year after year, the costs of providing care and running an office continue to rise.

My prescription: Scrap the SGR. Replace it with a payment structure that reflects the true costs of providing care in the 21st century.

We also need new approaches to physician payment that are rooted in the reality of how medical care is provided.

For example, Medicare should encourage better disease management, which is especially important for seniors in need of chronic care.

This has been a challenging year, and on an issue as complex as health system reform, it is inevitable that differences of opinion will arise.

However, the common ground we share is vast -- what divides us is not.

Thomas Jefferson once said: "Not every difference of opinion is a difference of principle."

The prescription for all of us: Support the AMA, support all our medical associations -- they focus light on the goals of our profession, the challenges we face, and our efforts to better serve our patients. Do not let others divide us.

Get involved. Make a difference. Because together we are stronger.

Cecil B. Wilson, MD is an internist in private practice in Winter Park, Fla. He served as chair of the AMA Board of Trustees during 2006-07 and was AMA president during 2010-11.

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