Shame on us all if we do nothing to fix health care

By Joseph W. Stubbs

As the president of the American College of Physicians, the second largest physician membership organization in the United States, representing 129,000 internal medicine physicians and medical student members, I write to urge passage of health care reform this year. The debate about health care reform has exploded over issues that have little or nothing to do with the health care legislation actually being developed by Congress.

To be perfectly clear, the proposed health care legislation is not about rationing care, socialized medicine or death panels. To the contrary, instead of leading to “rationing,” Congress would fund research to provide my patients and me with objective clinical information, based on the best science available, to choose the most effective treatment among the many available ones. And, instead of promoting “death panels,” the bill empowers patients to decide how they want to be treated at the end of life. Patients would make these decisions in consultation with their doctors — not government employees.

When I am not traveling around the country meeting with internists and other primary care physicians, I take care of patients in a general internal medicine practice in Albany, as I have done for the past 27 years. I take enormous professional pride and satisfaction in keeping my patients healthy, helping to heal them and providing comfort and relief when they are nearing the end of their life. I also share their frustrations with a health care system that is stacked against us both; a system that is unacceptable and unsustainable.

Examples readily come to mind to support this point. By 2017, an average middle-income family will spend $4 out of every $10 they earn on health care alone, putting it out of reach for most. Just three years later, the number of uninsured is expected to climb from today’s 46 million to 60 million, which is about one in five of our population. And, those with insurance will not be able to find a primary care doctor because of a growing primary care physician shortage of tens of thousands.

We have an opportunity to change this bleak picture. But we must recognize this situation as a time to come together with courage and solidarity of purpose rather than get caught up in politics that divert us from a common goal. Making sure that all of us can have affordable health insurance that can’t be taken away, even when we get ill or lose our jobs, does have a cost.

But that cost can largely be met by improving the efficiency, quality and coordination of the care we deliver and the efficiency and simplification of the health insurance that is provided. It can be done with our patients getting better care and not losing care. And it can be done without threatening the security of the lives of our children, our parents and grandparents.

The legislation is not perfect but let us not make perfect the enemy of good. Congress will be making changes in the bills to address voters’ concerns, but the one change we can’t afford is for Congress to do nothing.

We need health care coverage for all Americans with increased choices and increased security in knowing that your coverage will not be withheld because of pre-existing conditions and not lost because of the development of an illness. We need safeguards to prevent the cost of health care from bankrupting the family.

We need to promote primary care by providing scholarships and loan forgiveness to encourage young physicians to choose careers in primary care. We need to change the way doctors are paid to support the value of care provided by primary care physicians so that they will be able to provide better, more coordinated care for their patients.

Without these reforms, the United States will soon see a primary care physician shortage of 40,000, leading to higher costs, long waits for appointments and delayed care. We need meaningful reforms of an out-of-control malpractice system that reduces the enormous cost of defensive medicine while still providing compensation to patients who are harmed by medical negligence or errors.

The legislation being considered by Congress makes a good start on addressing many of these issues, but we need to keep the pressure on them to get the job done.

The reality is that if health reform fails, the result will be more uninsured patients, more families going bankrupt because of high health care bills, more cherry picking by insurance companies, Medicare insolvency and a critical shortage of primary care physicians. This is not a future I want for my patients, my family or the medical profession.

Within our grasp is the achievement of health reform legislation that makes coverage affordable by building upon and improving our current employer-based system, providing incentives for young doctors to go into primary care, reforming and improving Medicare physician payments, and reducing the costs associated with our broken medical liability system. Let’s not let the opportunity slip away.

Dr. Joseph W. Stubbs is president of the American College of Physicians and an internist in Albany.