Wisconsin Medical Journal
107 #2
107 #2
2008 Inaugural Address
The following Inaugural Address was given by President Steven C. Bergin, MD, Friday, April 11, 2008, during the Annual Meeting.
With the 2008 Presidential campaign in full swing, health care reform has jumped to the top of the nation’s domestic policy priorities. A recent Wall Street Journal/Harris Interactive Poll found that Americans consider providing health care coverage to the uninsured the most important health policy issue, with slowing inflation in health care costs a close second.
As Wisconsin physicians have we been listening to the health care concerns our patients have that contribute directly to the acute and chronic disease we treat? Or have we too narrowly focused our attention to the point-of-service complaints without looking at the broader coverage and cost issues they face continuously on a day-to-day basis.
I dare say we (myself included) have not been attentive and have allowed a “pustule” to become a “boil” that threatens the life of our health care system. We have watched passively in many quarters as the system has evolved into an 800-pound gorilla seen by many as uncontrollable. Yes, I have great concerns—but as Wisconsin physicians, let’s get rid of the pessimism—let’s pull our sleeves up and go to work!
Our current health care financing and delivery system is an outgrowth of the New Deal social contract advanced by President Franklin Roosevelt and implemented by the Truman administration. Employer-based health insurance was the vehicle developed to pay for health care and remains the cornerstone of today’s US health insurance system. It accounts for 62 percent of current health care coverage for the under-65 population—that equates to 160 million American lives.
Numerous efforts to revamp the system have failed since Harry Truman’s administration in the 1940s. However, a significant transformation in the health care system occurred in the 1960s with the passage of Medicare and Medicaid as a part of President Johnson’s War on Poverty social contract. Comprehensive health care reform attempts have since disappeared from the national agenda following the Clinton administration’s failure in its attempt to enact universal coverage in 1993 and 1994. We can debate as to the reasons behind the failure, but suffice it to say the complexities of the plan and the pointed exclusion of key stakeholders in the policy discussions contributed immensely. Since that time, Congress has only adopted incremental measures that have enjoyed bipartisan support—SCHIP and HIPAA being examples.
What then has triggered this intense renewal of interest in attempting to reform our health care system? Undoubtedly widespread public dissatisfaction with deteriorating health insurance coverage, steadily rising premiums and escalating health care costs have prompted the remaining presidential candidates to bring forward significant proposals for health care reform. Currently there is little provision for first dollar coverage for preventive care and screening measures in the majority of plans, and the insured have little to say in the choice of plans and coverage offered through the workplace. Further, the average premium for an average family of four has risen 91 percent since 2000, while wages have only increased by 24 percent. Health administrative costs during the same period have jumped 109 percent or 12 percent annually and account for roughly 30 percent of health care insurance premium dollars never reaching the public as health care.
Other senators and representatives, health policy analysts, labor leaders, business leaders, insurance leaders, organized medicine (your AMA) and patient advocacy groups have responded with numerous reform proposals. A window of opportunity appears to be opening: more than at any other point in recent history, there is agreement among this group of key stakeholders that attaining universal coverage, reforming the delivery system and controlling costs are imperatives and the attitude of “business as usual” is no longer acceptable. The remaining major candidates agree, and as Senator John McCain has so aptly said, “The United States is approaching a ‘perfect storm’ of problems that ‘will cause our health system to implode’ if the next president doesn’t act.”
What then is the growing evidence that indicates the current US health care system falls short in critical areas and is unsustainable?
I believe the answer to this question will become apparent as the following questions are considered.
How well does the US health system perform when compared with other nations?
In a recent Commonwealth Fund-supported study comparing preventable deaths in 19 industrialized countries, the United States ultimately placed last. While the rates of preventable deaths improved dramatically in other nations between the two study periods 1997-98 and 2002-03, the rate improved only slightly in the United States. More disturbing was the fact the US went from 15th ranking in the first arm of the study to 19th or last in 2002-03 analysis.
Another Commonwealth Fund Study published in May of 2007 compared the United States with five other industrialized nations on key dimensions of health system performance. Across the board, the US health system ranked last or next-to-last when assessing quality, access, equity, efficiency and healthy lives. Other specific examples from this six-country study showed the US had the highest rate of infant mortality and obesity and the lowest average life expectancy. Also it was shown we lag in the adoption of information technology that could potentially improve quality and efficiency of health care. Finally, it was observed that the US does a poor job of coordinating care for patients with chronic illnesses—an ever-growing population.
How does the US compare with other countries on spending for health care?
The US spends more per capita than any country in the world ($7,026)—more than double the average among Organization of Economic Cooperation and Development industrialized nations. From 2000 to 2006, total US spending increased from $1.4 trillion to $2.4 trillion. Currently the health care tab is 16 percent of our Gross Domestic Product and is anticipated to rise to 20 percent of Gross Domestic Product by 2016 unless health reforms are enacted. Moreover, with current funding growth trends, the two largest public health insurance programs—Medicare and Medicaid will increase from the current 5 percent of the GDP today to about 20 percent by 2050. Of further concern is a recent CMS report that hospital care expenditures will exceed Medicare taxes raised in 2008 and that without reform the trend will continue until projected insolvency occurs in 2019.
Why does the US health system fail to promote high performance?
First and foremost, access to care is unequal. The number of uninsured Americans has been increasing from 38.7 million in 2000 to 47 million in 2006—a 21 percent increase. Also, it is estimated there are 16 million under-65 Americans who are under-insured. The uninsured rates vary from state to state and range from just under 11 percent in Minnesota to as high as 30 percent in Texas. Many researchers using a variety of data sets and controlling for many potential confounders have documented higher health care costs are associated with lower levels of coverage. For instance Sheils et al estimate that a 1 percent increase in health insurance premiums nationally is associated with 300,000 individuals losing employer based coverage.
Chernew et al, using data from 64 large metropolitan areas between 1989 and 2000 reported a 1 percent health insurance premium increase resulted in a net increase in uninsured of 164,000 people. This same group in the 1990s calculated that increases in the cost of health insurance accounted for nearly two-thirds of the total decline in coverage during the study period.
As a result of unequal and poor access, it is difficult if not impossible for the uninsured to receive timely preventive and screening services and to receive proper care management for chronic conditions. This uncoordinated inefficient care translates into more acute hospitalizations, which contributes to the estimated 30-50 percent waste of health care dollars spent.
What is our patients’ view on health reform?
New survey data from the Commonwealth Fund indicates 81 percent of Americans favor keeping some form of employer-sponsored health insurance in order to extend coverage to all. The survey also found a wide majority of Democratic, Republican, and independent voters believe costs should be shared by individuals, employers and government. A majority of the public is also strongly or somewhat strongly in favor of requiring everyone to have health insurance coverage—with government subsidies for those who cannot fully support it.
What are the views of the health policy analysts?
Seventy percent of the health leaders surveyed indicate the next president should pursue universal health care coverage and at the same time develop polices to address quality, cost, efficiency and coordination of care issues.
The respondents to the Health Care Opinion Leader Survey included experts from academia—research organizations, physicians, business, insurance, labor, other health industry groups and government and consumer advocacy groups. This broad representative group of stakeholders favored a mixed private-public insurance model for reform. They expressed strong support for
In 2007 your AMA launched the “Voice of the Uninsured Campaign” to promote constructive change in the American health care system. Included in the proposal were three defined “pillars” to expand and improve American health care. Interestingly, there are common threads of agreement with the views of our patients and those of the health policy analysts in moving to universal coverage with cost containment and improving quality and coordinated efficient health care delivery.
What then are the health reform proposals being advanced by the remaining presidential candidates?
Both Democratic and Republican proposals seek to advance coverage through a mixed market approach but by different methods. The Democrats would require employers to continue participating in the system with insurance mandates. The Republican proposal would support change through tax code changes to provide incentives for individuals to buy in the private insurance market. The Democrats would require or mandate all individuals to have insurance while the Republican plan would not. The Democrats would broadly pool risk for those individuals in poor health to lower cost and there would be guarantee issue. The Republicans, on the other hand, would rely exclusively on individual markets without consumer protections to require insurance to extend coverage to high-risk groups.
Well now that we understand the scope of the health care problem and the proposals for remedy, will any of the proposed reforms succeed?
Analysts disagree on whether proposed changes as related to access, cost and quality will succeed. Our former Republican Governor and former Health and Human Services Secretary, Tommy Thompson, is very optimistic and says “2009 will be the biggest successful year in the transformation of health care that we have seen since the passage of Medicare and Medicaid in the 1960s.” Numerous health policy analysts, including Harvard’s Dr. Blendon (Professor of Health Policy) foresees a huge stalemate except around the issue of covering the nation’s children unless there is a sweep of Congress by one party. He believes the two parties are so far apart on solutions—and have become so polarized—that there is little common ground to effect positive change.
In my professional and personal life have I encountered health system failure?
In researching this issue and attempting to digest the voluminous reports and studies concerning our health care system, there was ample time to pause, reflect and sleep on it. I very quickly realized I didn’t have to search far to find real examples where our health system has failed and continues to fail. In fact, all I had to do was look at my own family.
My mother, 83, currently lives on a fixed income and fully 25 percent of her Social Security benefit goes to fund her GAP insurance. Even with Part D Medicare drug coverage, she pays a $35 medication co-pay monthly. My mother (if you haven’t noticed) has severe osteoporosis and has had a fractured hip in the past. She now has chronic back pain from her spinal stenosis. Unfortunately, a timely bone density was not completed that would have allowed for preventative treatment to be implemented. Was I a part of her problem? Absolutely, as I should have advocated more strongly on her behalf.
She has been a Type II diabetic for 30 years. Unlike many diabetics, she received excellent diabetic teaching, dietary instruction was monitored by a compulsive physician and above all recognized what her responsibilities were. Her care was subsequently transferred to another physician who did not follow the same coordinated care plan. I had the opportunity to accompany her as a civilian to a recent visit and was appalled with what I heard and what I didn’t hear. Needless to say, I didn’t hesitate—given she was angry over the less-than- concerned approach—her care has been transferred.
My father-in-law, 94, also has osteoporosis and chronic back pain secondary to spinal stenosis. Sadly, his osteoporosis potential was not considered because it wasn’t high on the provider’s radar screen. My father-in-law is also a colon cancer survivor. If screening colonoscopy had been performed in a timely fashion, there is high probability the costly radical surgery, postoperative abdominal abscess complications, intensive care, extended hospitalization and rehabilitation and adjunctive chemotherapy could have been avoided.
My sister-in-law recently retired, having worked her entire life with health care coverage purchased in the private market at a cost of $15,000 a year. It did provide for preventative care coverage—mammograms, colonoscopies, paps, etc. However, only recently did she have a bone density test as there was no prior direction to have the baseline study at or around menopause.
Then there is my eldest son, who is self-supporting but has no access to health care coverage and, as a result, preventative care. Income just doesn’t support premium cost. Fortunately, he has parents who have the ability to help. Just think of the millions of young women and men who don’t have that resource. The intent of these examples is not to point a finger at any one specific individual. For as my grandfather Miller used to say, “There is not one of us who is perfect.”
Instead, these examples clearly highlight the health care issues of access, cost, and quality we all face. When I was growing up I remember my dad saying to me often, “Now Steve, you can do better.” Yes, I believe we all can do better.
What can we as Wisconsin physicians do to advance meaningful health care reform?
As patient advocates, Wisconsin physicians have a particular stake in finding viable and effective approaches in providing access to coverage, controlling system costs and providing efficient, well-coordinated quality care. Although Wisconsin was just recognized as being number 2 nationally by the Agency for Healthcare Research and Quality (AHRQ) for providing high quality, low-cost care, we cannot rest on past laurels. We need to engage and offer to participate in the health care reform discussion with policy makers and all health care stakeholders. We must shed our professional cocoon and awaken from our political hibernation. We must become individually educated in understanding the complexities of our health care system. We need to realize there are no single solutions and frustration levels will be high as each of the confounding variables is addressed.
No longer can we just support the activities of our AMA, the Wisconsin Medical Society, our lobbying staff and professional leaders. We need to mount a vigorous sustained grass roots campaign engaging and dialoguing with local, state and national legislative representatives. We must bring our day-to-day professional experiences with the system to their attention. We must offer our time if asked and volunteer if not. We need to be respectful, open-minded and non-threatening in our interaction with all stakeholders. We should not off-handedly dismiss proposals just because they depart from the status quo or past policy. We must shed the image of being obstructionist as there is too much to lose.
Finally, our overall responsibility is to deliver safe, efficient, well-coordinated, cost effective care. We must consider costs when ordering laboratory and imaging tests, medications, and expensive technology. We must amplify our evidence-based care approach to managing disease and expand our best practice solutions.
It is critical to remember our patients are our partners in reforming the system. Therefore, we must empower and educate them as to their personal responsibility to live a healthy lifestyle, seek preventive care and screening services and to become more compliant in the management of their chronic illnesses. We need to convince insurance companies it is prevention-prevention-prevention.
The debate is in its early stages, and as we near the election more specifics regarding both party’s proposals will become available. Hopefully there will be a return to civility, dialogue and compromise—yes, even substantial bipartisanship to ensure Americans who already pay the most for health care, have a great health care system that offers access to all, cost containment, and quality, efficiency and coordinated health care.
Yes, the fix isn’t going to be easy as there are no simple solutions—but if we as physicians are to have any credibility with the patients we serve, we must take up the charge and stay the course.
With the 2008 Presidential campaign in full swing, health care reform has jumped to the top of the nation’s domestic policy priorities. A recent Wall Street Journal/Harris Interactive Poll found that Americans consider providing health care coverage to the uninsured the most important health policy issue, with slowing inflation in health care costs a close second.
As Wisconsin physicians have we been listening to the health care concerns our patients have that contribute directly to the acute and chronic disease we treat? Or have we too narrowly focused our attention to the point-of-service complaints without looking at the broader coverage and cost issues they face continuously on a day-to-day basis.
I dare say we (myself included) have not been attentive and have allowed a “pustule” to become a “boil” that threatens the life of our health care system. We have watched passively in many quarters as the system has evolved into an 800-pound gorilla seen by many as uncontrollable. Yes, I have great concerns—but as Wisconsin physicians, let’s get rid of the pessimism—let’s pull our sleeves up and go to work!
Our current health care financing and delivery system is an outgrowth of the New Deal social contract advanced by President Franklin Roosevelt and implemented by the Truman administration. Employer-based health insurance was the vehicle developed to pay for health care and remains the cornerstone of today’s US health insurance system. It accounts for 62 percent of current health care coverage for the under-65 population—that equates to 160 million American lives.
Numerous efforts to revamp the system have failed since Harry Truman’s administration in the 1940s. However, a significant transformation in the health care system occurred in the 1960s with the passage of Medicare and Medicaid as a part of President Johnson’s War on Poverty social contract. Comprehensive health care reform attempts have since disappeared from the national agenda following the Clinton administration’s failure in its attempt to enact universal coverage in 1993 and 1994. We can debate as to the reasons behind the failure, but suffice it to say the complexities of the plan and the pointed exclusion of key stakeholders in the policy discussions contributed immensely. Since that time, Congress has only adopted incremental measures that have enjoyed bipartisan support—SCHIP and HIPAA being examples.
What then has triggered this intense renewal of interest in attempting to reform our health care system? Undoubtedly widespread public dissatisfaction with deteriorating health insurance coverage, steadily rising premiums and escalating health care costs have prompted the remaining presidential candidates to bring forward significant proposals for health care reform. Currently there is little provision for first dollar coverage for preventive care and screening measures in the majority of plans, and the insured have little to say in the choice of plans and coverage offered through the workplace. Further, the average premium for an average family of four has risen 91 percent since 2000, while wages have only increased by 24 percent. Health administrative costs during the same period have jumped 109 percent or 12 percent annually and account for roughly 30 percent of health care insurance premium dollars never reaching the public as health care.
Other senators and representatives, health policy analysts, labor leaders, business leaders, insurance leaders, organized medicine (your AMA) and patient advocacy groups have responded with numerous reform proposals. A window of opportunity appears to be opening: more than at any other point in recent history, there is agreement among this group of key stakeholders that attaining universal coverage, reforming the delivery system and controlling costs are imperatives and the attitude of “business as usual” is no longer acceptable. The remaining major candidates agree, and as Senator John McCain has so aptly said, “The United States is approaching a ‘perfect storm’ of problems that ‘will cause our health system to implode’ if the next president doesn’t act.”
What then is the growing evidence that indicates the current US health care system falls short in critical areas and is unsustainable?
I believe the answer to this question will become apparent as the following questions are considered.
How well does the US health system perform when compared with other nations?
In a recent Commonwealth Fund-supported study comparing preventable deaths in 19 industrialized countries, the United States ultimately placed last. While the rates of preventable deaths improved dramatically in other nations between the two study periods 1997-98 and 2002-03, the rate improved only slightly in the United States. More disturbing was the fact the US went from 15th ranking in the first arm of the study to 19th or last in 2002-03 analysis.
Another Commonwealth Fund Study published in May of 2007 compared the United States with five other industrialized nations on key dimensions of health system performance. Across the board, the US health system ranked last or next-to-last when assessing quality, access, equity, efficiency and healthy lives. Other specific examples from this six-country study showed the US had the highest rate of infant mortality and obesity and the lowest average life expectancy. Also it was shown we lag in the adoption of information technology that could potentially improve quality and efficiency of health care. Finally, it was observed that the US does a poor job of coordinating care for patients with chronic illnesses—an ever-growing population.
How does the US compare with other countries on spending for health care?
The US spends more per capita than any country in the world ($7,026)—more than double the average among Organization of Economic Cooperation and Development industrialized nations. From 2000 to 2006, total US spending increased from $1.4 trillion to $2.4 trillion. Currently the health care tab is 16 percent of our Gross Domestic Product and is anticipated to rise to 20 percent of Gross Domestic Product by 2016 unless health reforms are enacted. Moreover, with current funding growth trends, the two largest public health insurance programs—Medicare and Medicaid will increase from the current 5 percent of the GDP today to about 20 percent by 2050. Of further concern is a recent CMS report that hospital care expenditures will exceed Medicare taxes raised in 2008 and that without reform the trend will continue until projected insolvency occurs in 2019.
Why does the US health system fail to promote high performance?
First and foremost, access to care is unequal. The number of uninsured Americans has been increasing from 38.7 million in 2000 to 47 million in 2006—a 21 percent increase. Also, it is estimated there are 16 million under-65 Americans who are under-insured. The uninsured rates vary from state to state and range from just under 11 percent in Minnesota to as high as 30 percent in Texas. Many researchers using a variety of data sets and controlling for many potential confounders have documented higher health care costs are associated with lower levels of coverage. For instance Sheils et al estimate that a 1 percent increase in health insurance premiums nationally is associated with 300,000 individuals losing employer based coverage.
Chernew et al, using data from 64 large metropolitan areas between 1989 and 2000 reported a 1 percent health insurance premium increase resulted in a net increase in uninsured of 164,000 people. This same group in the 1990s calculated that increases in the cost of health insurance accounted for nearly two-thirds of the total decline in coverage during the study period.
As a result of unequal and poor access, it is difficult if not impossible for the uninsured to receive timely preventive and screening services and to receive proper care management for chronic conditions. This uncoordinated inefficient care translates into more acute hospitalizations, which contributes to the estimated 30-50 percent waste of health care dollars spent.
What is our patients’ view on health reform?
New survey data from the Commonwealth Fund indicates 81 percent of Americans favor keeping some form of employer-sponsored health insurance in order to extend coverage to all. The survey also found a wide majority of Democratic, Republican, and independent voters believe costs should be shared by individuals, employers and government. A majority of the public is also strongly or somewhat strongly in favor of requiring everyone to have health insurance coverage—with government subsidies for those who cannot fully support it.
What are the views of the health policy analysts?
Seventy percent of the health leaders surveyed indicate the next president should pursue universal health care coverage and at the same time develop polices to address quality, cost, efficiency and coordination of care issues.
The respondents to the Health Care Opinion Leader Survey included experts from academia—research organizations, physicians, business, insurance, labor, other health industry groups and government and consumer advocacy groups. This broad representative group of stakeholders favored a mixed private-public insurance model for reform. They expressed strong support for
- Insurance market regulation to secure insurance for people who are sicker;
- Mandate individual health insurance—with subsidies for low and moderate income people;
- Expand the federal-state Medicaid and SCHIP programs to include adults at poverty level or above;
- Require employers to contribute to health insurance coverage by either contributing to their workers premiums or to a broader community or state pool;
- Include a public plan option like Medicare to help extend health insurance coverage.
- Expanding use of information technology to improve health care quality
- Allowing public plans like Medicare to compete with private insurance plans, and
- Permitting Medicare to negotiate prescription drug prices as a way to reduce growth in health care costs.
In 2007 your AMA launched the “Voice of the Uninsured Campaign” to promote constructive change in the American health care system. Included in the proposal were three defined “pillars” to expand and improve American health care. Interestingly, there are common threads of agreement with the views of our patients and those of the health policy analysts in moving to universal coverage with cost containment and improving quality and coordinated efficient health care delivery.
What then are the health reform proposals being advanced by the remaining presidential candidates?
Both Democratic and Republican proposals seek to advance coverage through a mixed market approach but by different methods. The Democrats would require employers to continue participating in the system with insurance mandates. The Republican proposal would support change through tax code changes to provide incentives for individuals to buy in the private insurance market. The Democrats would require or mandate all individuals to have insurance while the Republican plan would not. The Democrats would broadly pool risk for those individuals in poor health to lower cost and there would be guarantee issue. The Republicans, on the other hand, would rely exclusively on individual markets without consumer protections to require insurance to extend coverage to high-risk groups.
Well now that we understand the scope of the health care problem and the proposals for remedy, will any of the proposed reforms succeed?
Analysts disagree on whether proposed changes as related to access, cost and quality will succeed. Our former Republican Governor and former Health and Human Services Secretary, Tommy Thompson, is very optimistic and says “2009 will be the biggest successful year in the transformation of health care that we have seen since the passage of Medicare and Medicaid in the 1960s.” Numerous health policy analysts, including Harvard’s Dr. Blendon (Professor of Health Policy) foresees a huge stalemate except around the issue of covering the nation’s children unless there is a sweep of Congress by one party. He believes the two parties are so far apart on solutions—and have become so polarized—that there is little common ground to effect positive change.
In my professional and personal life have I encountered health system failure?
In researching this issue and attempting to digest the voluminous reports and studies concerning our health care system, there was ample time to pause, reflect and sleep on it. I very quickly realized I didn’t have to search far to find real examples where our health system has failed and continues to fail. In fact, all I had to do was look at my own family.
My mother, 83, currently lives on a fixed income and fully 25 percent of her Social Security benefit goes to fund her GAP insurance. Even with Part D Medicare drug coverage, she pays a $35 medication co-pay monthly. My mother (if you haven’t noticed) has severe osteoporosis and has had a fractured hip in the past. She now has chronic back pain from her spinal stenosis. Unfortunately, a timely bone density was not completed that would have allowed for preventative treatment to be implemented. Was I a part of her problem? Absolutely, as I should have advocated more strongly on her behalf.
She has been a Type II diabetic for 30 years. Unlike many diabetics, she received excellent diabetic teaching, dietary instruction was monitored by a compulsive physician and above all recognized what her responsibilities were. Her care was subsequently transferred to another physician who did not follow the same coordinated care plan. I had the opportunity to accompany her as a civilian to a recent visit and was appalled with what I heard and what I didn’t hear. Needless to say, I didn’t hesitate—given she was angry over the less-than- concerned approach—her care has been transferred.
My father-in-law, 94, also has osteoporosis and chronic back pain secondary to spinal stenosis. Sadly, his osteoporosis potential was not considered because it wasn’t high on the provider’s radar screen. My father-in-law is also a colon cancer survivor. If screening colonoscopy had been performed in a timely fashion, there is high probability the costly radical surgery, postoperative abdominal abscess complications, intensive care, extended hospitalization and rehabilitation and adjunctive chemotherapy could have been avoided.
My sister-in-law recently retired, having worked her entire life with health care coverage purchased in the private market at a cost of $15,000 a year. It did provide for preventative care coverage—mammograms, colonoscopies, paps, etc. However, only recently did she have a bone density test as there was no prior direction to have the baseline study at or around menopause.
Then there is my eldest son, who is self-supporting but has no access to health care coverage and, as a result, preventative care. Income just doesn’t support premium cost. Fortunately, he has parents who have the ability to help. Just think of the millions of young women and men who don’t have that resource. The intent of these examples is not to point a finger at any one specific individual. For as my grandfather Miller used to say, “There is not one of us who is perfect.”
Instead, these examples clearly highlight the health care issues of access, cost, and quality we all face. When I was growing up I remember my dad saying to me often, “Now Steve, you can do better.” Yes, I believe we all can do better.
What can we as Wisconsin physicians do to advance meaningful health care reform?
As patient advocates, Wisconsin physicians have a particular stake in finding viable and effective approaches in providing access to coverage, controlling system costs and providing efficient, well-coordinated quality care. Although Wisconsin was just recognized as being number 2 nationally by the Agency for Healthcare Research and Quality (AHRQ) for providing high quality, low-cost care, we cannot rest on past laurels. We need to engage and offer to participate in the health care reform discussion with policy makers and all health care stakeholders. We must shed our professional cocoon and awaken from our political hibernation. We must become individually educated in understanding the complexities of our health care system. We need to realize there are no single solutions and frustration levels will be high as each of the confounding variables is addressed.
No longer can we just support the activities of our AMA, the Wisconsin Medical Society, our lobbying staff and professional leaders. We need to mount a vigorous sustained grass roots campaign engaging and dialoguing with local, state and national legislative representatives. We must bring our day-to-day professional experiences with the system to their attention. We must offer our time if asked and volunteer if not. We need to be respectful, open-minded and non-threatening in our interaction with all stakeholders. We should not off-handedly dismiss proposals just because they depart from the status quo or past policy. We must shed the image of being obstructionist as there is too much to lose.
Finally, our overall responsibility is to deliver safe, efficient, well-coordinated, cost effective care. We must consider costs when ordering laboratory and imaging tests, medications, and expensive technology. We must amplify our evidence-based care approach to managing disease and expand our best practice solutions.
It is critical to remember our patients are our partners in reforming the system. Therefore, we must empower and educate them as to their personal responsibility to live a healthy lifestyle, seek preventive care and screening services and to become more compliant in the management of their chronic illnesses. We need to convince insurance companies it is prevention-prevention-prevention.
The debate is in its early stages, and as we near the election more specifics regarding both party’s proposals will become available. Hopefully there will be a return to civility, dialogue and compromise—yes, even substantial bipartisanship to ensure Americans who already pay the most for health care, have a great health care system that offers access to all, cost containment, and quality, efficiency and coordinated health care.
Yes, the fix isn’t going to be easy as there are no simple solutions—but if we as physicians are to have any credibility with the patients we serve, we must take up the charge and stay the course.
© Wisconsin Medical Society - All rights reserved - 2008
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