The AMA and U.S. electorate share a unity of purpose

As I reflect on the Interim Meeting, which took place just four days after the re-election of President Obama and five months after the U.S. Supreme Court decision upholding the Affordable Care Act, it appears to me that the American Medical Association and the American electorate are in agreement concerning the transformation of our health system.

As I see it, on Nov. 6, voters told members of Congress that we’re tired of gridlock and anxious to see them working together again. They also made it clear that implementation of the Affordable Care Act would continue.

Those messages were front and center at the AMA Interim Meeting in November, although when I had the chance, I reminded the House of Delegates that the ACA is only a first step toward real health system reform.

Nonetheless, I was proud to be present as this great body of America’s physicians joined together to reinforce our commitment to a better system of health care, one that embodies physician-led teams and a coherent and compassionate approach to Medicare and underserved patients.

Working through the democratic process, this House of Delegates enacted policies that impact the entire health care system and every patient — with every vote based on the assumption that we physicians remain in there, fighting for the kind of 21st-century health care that works best for physicians and patients.

As we have in the past, the AMA will continue to focus our efforts on new and returning elected leaders on both sides of the aisle. We will continue our work to perfect the Affordable Care Act over the coming months. We also will remind those elected officials and policymakers that even the most skilled physician can’t cure social determinants of health like poverty, unemployment, and limited or no access to transportation, exercise resources or healthy food. And we will urge those elected officials to take this into consideration as they do their share in building a better, more equitable system.

One of the most critical emerging issues as we look to 2014 and full implementation of the ACA is one that was addressed and debated during the House of Delegates meeting in Hawaii — that of uninsured low-income individuals and those with incomes between 133% and 200% of the federal poverty level.

Under current law, states are empowered to create an alternative Basic Health Program separate and apart from Medicaid to cover these people. However, as HHS and the states have been moving toward implementation of these basic health plans, questions have arisen regarding the potential effects on patient care, physician payment and practice; on Medicaid and the new health insurance exchanges; and, most important, the patient-physician relationship. This one issue alone shows just how important it is that physicians be involved in the implementation process as states look to create these alternative programs.

And then there were the other long-existing issues that continue to demand our attention. These are issues like:

• The Independent Payment Advisory Board, which should be scrapped outright.
• The flawed, costly medical liability system.
• The ability to contract privately with Medicare patients, as outlined in the Medicare Patient Empowerment Act.
• The broken Medicare physician payment formula, the sustainable growth rate.

In October, the AMA and 110 state and specialty societies fired a joint letter to congressional leaders demanding a fix for the broken SGR. It was a unified message only the AMA could deliver — and because of that unity, it got the attention of Congress and the White House. We told them that delivery reform is needed to offer patient choice and options, that Medicare must support the physician infrastructure reform demands, and that payment must reflect the costs of providing services as well as progress on quality and cost.

The power behind our message was clear — it showed that the AMA, state societies and specialties are working together in the interests of our patients and profession.

The reaction to our message also reminded us how important it is that physicians remain united and continue to speak with one voice as we address these critical issues.

This unity of purpose has made the AMA a powerful force in the nation’s health care policies. This is even more important because we practice the art and science of medicine in a world that would have astonished our fathers and grandfathers: an electronically connected world of big insurance and big government; a growing shortage of physicians; an aging population with multiple chronic conditions; and 6,000 drugs and 4,000 clinical procedures to choose from. It is a world where integrated physician-led medical teams are the way of the future.

It once made sense for physicians to value autonomy, independence, and self-sufficiency. But even in those days, they saw the value of coming together on behalf of larger issues like medical education, ethics and public health. And so they founded the AMA.

Today, our unity is even more important. For that reason, it was gratifying for me to see and hear not only the debates — which were many — but also to witness the coming together in recognition of the role that physicians must play as we interact with our patients and play an ever-more-important role in the larger world as well.

Our Interim Meetings, like any national election, are milestones. They are a time to assess how far we have come, and then reset the clock, so to speak, as we move forward once more.

As I told the delegates in Hawaii, it seems to me the stars have aligned for us in such a way as to assure the transformation of our health care system — provided we are on hand to assure that our government officials follow the rules reaffirmed by our House of Delegates. And that is, to look first at what is best for the physicians and patients of this nation.