Implementing the Patient Protections and Affordable Care Act (PPACA) will be a monumental task and there are plenty of legitimate landmines planted by the legislation that we will have to wok hard to avoid. One of the things we should not be wasting any time and energy on, however, is whether the individual mandate is unconstitutional.
Twenty states are challenging PPACA in court to prevent its implementation. My group, Doctors for America, and many others are pushing back on these efforts, which we see as counterproductive, wasteful of precious resources (better spent on actual health care), and designed largely to fan the dying embers of the misinformation campaign we all withstood in August of 2009.
I am not naïve enough to get upset when politicians (surprise!) “play politics” with an issue. That’s like Chris Rock’s old line about Seigfried and Roy’s tiger, “That tiger didn’t go crazy, that tiger went tiger!” So fine, politicians are using the sliver of an opening they see in the legislation to demagogue all the way to the Supreme Court. But in a country that already spends nearly 20% of GDP on health care, can we really afford to waste time and energy on this pointless exercise?
Nearly fifty years ago now, Ronald Reagan famously crusaded against Medicare, declaring on an AMA sponsored program, that, if Medicare passed, “…one of these days, you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America, when men were free.” Those sunset years are long gone, and here we are, still in America, still free, sky still blue, water still wet.
And this time around, the AMA and nearly every other major physician organization was in favor of reform! All of the ten largest physician organizations were supporting the health reform bill that came out of the House of Representatives. Almost all stayed on, even after the opposing forces stripped away the Sustainable Growth Rate (SGR) fix, and even though liability caps were not included in the final bill!
Why? Because in spite of this being a controversial bill, besides it being cumbersome and confusing and complex, and despite all of the misinformation and fearmongering, the PPACA is going to accomplish some very important things, and put us on a path to fixing many more.
It is important for us as physicians, medical professionals and human beings to advocate for expanded access to health care. It is part of the Charter on Medical Professionalism to advocate for fair and universal access to healthcare. It is part of our duty to advocate not only for the patients in front of us, but to advocate for those who can’t afford to see any of us. It is part of our duty to advocate for the dignity of the individual, to allow them to access health care without begging for themselves or their families.
I remain very proud of organized medicine, particularly those leaders who stood up to some serious vitriol from their members. It is one thing to be an individual physician and stay true to one’s ideology, but it is quite another to be in the leadership of the profession and put blinders on for the sake of ideologic purity and ignore the unconscionable suffering taking place in the richest country in the world. They do not have the luxury of sacrificing health care reform to abstract, ideological purity, they are faced with moving forward or not moving. They have chosen the moral, professional path.
Mike Huckabee, in a recent interview talked about this dilemma. Yes, it would be nice, he said, to stand on ideological purity and demand a pure free market system, but that doesn’t get the kid with asthma into the emergency room or the pediatrician’s office. It is just not reasonable for physicians (and others, for that matter) to try to kill health reform on a Constitutional altar and revert back to the trajectory we were on without PPACA: wildly, continually and uncontrollably rising costs, millions without insurance, millions foregoing vital chronic and preventative care, hundreds of thousands suffering while avoiding the expense of health care and tens of thousands literally dying without proper care.
PPACA has already resulted in some real benefits to real people, with provisions such as first dollar coverage for preventive services, allowing parents to keep adult children covered under their insurance, pre-existing condition programs, ending life-time coverage limits, ending rescissions, tax credits for small businesses, and more kicking in right now.
As I said, implementation will be hard, and as various provisions start looming, we will have to work very hard with our elected leaders to make the best product we can. There are some big landmines in there, including SGR, establishing Accountable Care Organizations, developing Comparative Effectiveness Research programs, and the Medicare Independent Payment Advisory Board.
These are going to be difficult and I am sure contentious issues, but if physicians engage and work in good faith with the public, our patients, and our elected officials and administrators, I am truly optimistic that we really can end up at the end of this journey with a health care system that lives up to our American ideals.
The leadership of the Pennsylvania Medical Society (PAMED) is taking up this challenge. The Board of Trustees has been working for months on a blueprint document detailing how physicians should be involved in reform implementation.
At the annual House of Delegates meeting this October, PAMED will take the unprecedented step of engaging with physician leaders in finalizing this blueprint. PAMED recognizes the critical importance of physician involvement in the implementation process and, as far as I know, is the only state medical society taking an aggressive, proactive posture to ensure physician leadership engagement. This is exemplary leadership.
So, to those fighting PPACA in court, including Attorney General Corbett, I say, we have a long road ahead of us. Let’s stop wasting our time on an ideological battle that provides no vaccinations, no antibiotics, no inhalers, and no health care for anyone.
Dr. Hughes is a practicing intensive care physician in the Pittsburgh area and Pennsylvania State Director of Doctors for America and a Trustee of the Pennsylvania Medical Society. His views are his own and do not represent any organization.