SGIM FORUM 2012; 35(8)

FROM THE EDITOR A Country Divided Over Health Care Priya Radhakrishnan, MD

Dr. Radhakrishnan is editor of Forum and can be reached at [email protected].

he US Supreme court passed the need more of them. We want their tion of Labor Legislation (AALL) was Thistoric verdict on the Patient help, and gradually we’re getting it. founded in Wisconsin by economists Protection and Affordable Care Act The problem however is more com- at the University of Wisconsin. In (aka Affordable Care Act, ACA) on plicated because they do not com- 1916, the AMA supported a govern- June 28, 2012. Chief Justice John prehend what we’re trying to do. We ment-run health insurance only to re- Roberts delivered the opinion of the do not cover doctors bills here, we verse its position in 1920. From the Court with respect to Part III-C, con- do not affect the freedom of choice. early 1900s, at regular frequency, cluding that the individual mandate You can go to any doctor you want. bills were introduced to set up a na- may be upheld as within Congress’s The doctor and you work out your tional health insurance only to die in power under the Taxing Clause. This arrangements with him—we talk committee. President Roosevelt, fol- concluded the first step of the jour- about his hospital bill. And that’s an lowed by Presidents Truman, Eisen- ney toward broadening health cover- entirely different matter. And I hope hower, and Kennedy, supported age and holding the health care that one by one the doctors of the national health insurance, yet it took industry accountable for the quality United States will take the extraordi- about 65 years of intense turmoil and of care. nary step of not merely reading the politicking to get the “Mills Bill” The law was signed by President journals and publications of the AMA passed in the Senate. President Barack Obama on March 23, 2010, because I do not recognize the bill Johnson signed Medicare (as part of under intense turmoil. Two years when I hear those descriptions. the Social Security Amendments of later, with upcoming general elec- 1965) into law on July 30, 1965. tions, the country is right back on the Fast forward 50 years later to During the last presidential elec- emotional roller coaster—this time President Obama’s weekly address tions, I came across a sign held by a evenly split with 46% vehemently to the nation (HHS blog): senior supporting the Tea Party at a opposing and 46% supporting the rally. Her placard screamed, “Govern- law. The health law gives hard working, ment get out of Medicare!” Shortly What is interesting about the cur- middle-class families the security after the Supreme Court ruling, as I rent health care political climate is they deserve. The Affordable Care concluded a medical visit with a spry 1 the fact that the stories and the con- Act forces insurance companies to 78-year-old patient of mine, I was re- versations are similar to those at the play by the rules, prohibiting them minded, “Now, Doctor, make sure turn of the century with one major from dropping your coverage if you that the government does not inter- difference. Then the opposition was get sick, billing you into bankruptcy fere in my testing.” She was sure from the American Medical Associa- through annual or lifetime limits, and, that her individual rights would be tion and the Republican party. Today soon, discriminating against anyone compromised by the ACA, her taxes the doctors appear largely on the with a pre-existing condition. For se- would go up, and the world as we fence or in favor of the law. niors, the new health care law, the know it would end. In an interview At a Medical Care for the Aged Affordable Care Act, not only means with Piers Morgan (CNN), Congress- rally at Madison Square Garden on more time with their doctor and im- woman Michelle Bachman played to May 20, 1962, President Kennedy portant new benefits like free pre- the same audience: “My 81-year-old spelled it out in no uncertain terms: ventive services like cancer grandmother does not need the gov- screenings and annual wellness vis- ernment dictating her care.” What The point of the matter is, that the its, but it also means more money in she conveniently did not add was AMA is doing very well in its efforts their pocket. The new health care that her 81-year-old grandmother to stop this bill. And the doctors of law strengthens Medicare. was probably on Medicare, a “gov- New Jersey and of every other state ernment run insurance.” may be opposed to it, but I know The fundamental question at the While there is universal skepti- that not a single doctor, if this bill is turn of the 20th century is the same cism regarding the government’s passed, is going to refuse to treat today: What is the role of the federal ability to ensure that the health cov- any patient. No one would become a government? Is the federal govern- erage expansion will be efficient and doctor just as a business enterprise, ment overstepping its role? indeed cost effective without com- it’s a long laborious discipline. We In 1906, the American Associa- continued on page 2 FROM THE EDITOR continued from page 1

promising quality, collectively we as would appear, is focused on ideologi- expansion induces a sense of fore- a nation should take some lessons cal differences. boding and paranoia that is not un- from history. Forty-seven years after While the Internet and Twitter expected: Medicaid has a reputation the formation of Medicare, we take have gone wild with physicians blog- for inefficiency. However, the suc- federal health insurance for seniors ging and tweeting about the news, cessful Medicaid programs, includ- for granted. There is no question in there has been limited coverage in ing the Arizona State Medicaid the minds of the public that seniors the mainstream media. It would ap- program (Arizona Health Care Cost should have universal health insur- pear based on the polls following Containment Program), are not men- ance. The path from idea to incep- the ruling that the country is sharply tioned in the national story as impor- tion took several decades. Now we divided. A few decades ago the tant pilots—probably because of the should all take a collective national AMA was holding rallies to derail intense political wars. (And, yes, Ari- deep breath, and rather than fuel Medicare; today there are only a zona is a Republican state). the fire with misinformation, we few physicians stories in the main- It is becoming increasing obvious should look forward to improving stream media. It would appear that that if the medical community be- our health system. the real news story is focusing on lieves in the Patient Protection & Ac- As we look around us, the lack of radical and hyped rhetoric rather countable Care Act, our organizations physician involvement in the main- than what’s happening on the and physicians should consider tak- stream media debate is startling. ground. The patient-centered med- ing a stance and explaining to the lay Short of Sanjay Gupta and a handful ical home pilots, including the story public what the Act is really about of medical professionals, there are of rebuilding the health system in and how it impacts them. For pri- few conversations showcasing physi- New Orleans and the subsequent mary care physicians, it would ap- cians and patients. Rather than ex- de-funding of several projects, is all pear the time of reckoning is here. ploring the issues and helping the but forgotten. The ACA has in its public make an informed opinion, the framework the potential to redesign References media are focused on the story of di- the health system based on these 1. http://www.supremecourt.gov/ visiveness. The national story, it successful programs. The Medicaid opinions/11pdf/11-393c3a2.pdf SGIM 2

SGIM FORUM 2012; 35(8)