O Brother, Where Art Thou?
In yesterday’s Wall Street Journal, Tennessee Governor Phil Bredesen presented a well-written argument to show how many employers may benefit financially under the new healthcare law by no longer providing insurance coverage to their employees as a direct benefit of employment. Today, Louisiana Governor Bobby Jindal announced that his state would delay changes to the Medicaid system that would have made care available to thousands of the poorest citizens of his state due to opposition from many hospitals there.
As I read both of these pieces, I couldn’t help but notice something, or should I say someone, continues to be conspicuously absent from these discussions. Throughout Governor Bredesen’s piece he refers to “coverage,”“plans,” and “employers” caring for patients. Governor Jindal’s plan refers to “coordinated care networks” caring for patients. Networks, plans, and employers do not care for patients – physicians do.
As politicians and businesses scramble to try to define and implement the new normal, physicians continue to be seen at only at the end of every story, simply reacting to each new twist in interpretation of the law as it is imposed. With few exceptions, physicians seem to be content to follow the actions of others.
I am not calling for a massive rebellion on the physician front, but simply for individual physicians to begin to take a leadership role in the process. Ask most physicians and they will agree that the current delivery system is unsustainable and that changes must be made. If we as physicians want to be more than a footnote in this process, then we must begin to take a more active role in shaping it as it unfolds.
With regards to your final statement, no question....BUT... Physicians have never *spoken* as a unified voice, and likely never will. Most docs have lost faith in the AMA. Many of the considerations at CMS could fragment us even further ---The ACO model could put an even larger wedge between *specialists* and PCPs.
All we need to do is look to MA.... more MDs per capita than nearly anywhere else.... more insured (as percentage of total) than any other state, and yet there is a huge problem in terms of access, because there are still far too few MDs to serve the needs of the states patient population.
Physicians should be part of the solution --- and we can not simply stand back and wait for someone to ask us if we want to be involved!!! :-)
Perhaps your next piece can focus on specific ways docs can engage???