I speak as an emergency physician and one of the Mad As Hell Doctors from Oregon and share the the angst in your comments.

That said, it is very difficult to support what is making it through Congress. The individual mandate will line the pockets of the insurance companies with MORE public money. We will continue to have a sick care non-system that is designed to serve the Health Insurance and Drug Industries. The token improvements will not change the balance of political power that follows the money. We need more than incremental change.

Let’s call this “reform” what it is. It’s a near total sell out to the industry. I honestly don’t understand why they are resisting it, except that they win either way. It is really a shame that the physician community is mostly remaining silent. I believe physicians are a much bigger part of this problem than we are willing to admit. At the risk of being “divisive”, I believe many of the specialist are extremely comfortable with their very high incomes… and while NPA and DFA continue to advocate with patients’ interests at heart, the AMA ONLY cares about sustaining high physician income.

We need to continue to speak up. You are correct, whether or not this lame bill gets passed, and it seems to have less to do with health care than politics, the fight is just beginning. We must do all we can to activate the caring physician community.

Val and phochfeld,
I think we need to keep all this in perspective: in the last year or so the discussion in Congress has changed from healthcare reform to health-insurance reform. This has been acknowledged by Obama and almost all the Congressional members who are honest about it. For me, this has helped me curb my anger at what Congress is trying to accomplish now AND help me focus on what is still ahead.
With that in mind, I have to agree with Val that there will be some positive gains from even the watered-down Senate bill, but I also agree with phochfeld that the insurance companies will not only benefit from these legislations but will also find loopholes to side-step the regulations (they have a great track record for this and Lieberman continues to work hard to assure that they will be able to continue).
I think the anger we all feel is that all this political capital will result (at best) in only a mere inkling of real healthcare system reform. As we in the front line of healthcare delivery know all too well, not all health insurance is the same and even universal coverage and tighter regulations will not give patients better access or better care. In fact, the stress on expansion of Medicaid in both the House and Senate bills will already stress this ‘second rate’ insurance system and make it worse for access than it is now.
I think that it is now that the NPA needs to look to the future to change what is clearly NOT the healthcare reform that our patients and doctors deserve! I encourage members of the NPA to look into the EMBRACE proposal that was published in the Annals of Internal Medicine in April (unfortunately too late for the current healthcare debate). It is a blueprint for an overhaul of our existing healthcare system based on the goals and ideals of ‘single payer” systems but made to fit into the American social and political reality. I encourage NPA members to read the plan on our website (www.hpfhr.org) and I would welcome comments, questions, and discussions here or by emailing me at: gl@hpfhr.org.

Thank you Val for so beautifully articulating the hurt and frustration surrounding this current reform process. At least this time, as opposed to the numerous attempts at reform in the past, there have been physician voices supporting reform that benefits our patients and the health of our population. I am enormously proud of the work done by you and our physician community. The need will not end with whatever legislation passes. The NPA was founded to give voice and a vehicle for action to physicians who see their profession as one of service, integrity and advocacy. Now and moving forward we will need to grow the chorus of voices in every state and every community to ensure enactment of the progress we have made and push to help those left behind. No one knows this, lives this or is a greater champion than the docs on the front lines. This year we will be working hard to build NPA local action networks around the country to engage and involve doctors’ involvement in the policies and implementation in their home towns. I encourage everyone to join us for our National Meeting in Long Beach, CA March 13-15. There we will be learning about the details of our health care system as it looks now and how we can participate and influence systems moving forward. Additionally it will be an opportunity to meet physicians of shared values from around the country. I hope to see you all there.

I tend to agree with those who believe that this long process which started with such promise has resulted in a pair of bills from whicn we are very unlikely to get meaningful reform, and I am disgusted enough that I am ready to say “scrap it all and let’s get back to the drawing board.” I appreciate Val’s persepctive, that both remaining versions have enough good to make passage worthwhile, but I am anxious that passing the wrong fix now will make it harder to get the right fix later.

In teaching Healthcare policy over the last few years, I have always said to may trainees, “Whatever comes next, someone is going to have to take a pay cut.” I thought it was a given that we would not be able to do this without major changes in how we allocate the healthcare dollar. I have been shocked to see how little attention has been seriously directed at reducing utilization and reducing spending. Indeed, the fact that an SGR fix (preventing any meaningful cuts in reimbursement) was proposed in parallel with the existing bills, indicates the fate of this reform: Every group with a stake in it will work end-arounds to assure that Healthcare for all does not require any sacrifice from their group.

I have learned a lot through this process. I am somewhat jaded and hopeful that something good comes of this.

Hi Valerie,

Take heart!

The Congress of the United States is very close to doing something seven presidents have failed to get it to do,across my entire lifetime, pass any sort of meaningful health care reform.

Further, the NPA, and the movement it has helped spark, nurture, and promote, has been part of the reason a century of cruel American indifference is melting.

True, there are a number of US Senators who now fill me with true disgust. The GOP leads that list, with its rather extraordinary depth of cynicism, cruelty, reaction, and loss of reason.
Joe Lieberman and Ben Nelson will linger in my mind as two people who have betrayed the very basics of human decency and my trust.

But that is to be expected. That has happened every time a president tried to pass reform.

Over the last 100 years, such cruel tactics have worked, every time, and all the way.

That is, every time health care reform has been proposed, not one provision has passed, every time.

Not this time.

Thanks to you and many others, the Congress is 2-3 votes away from passing history-changing legislation. As big a bill as Social Security in 1935. Likely the biggest win for liberals since 1935.

Is it flawed, have key provisions been gutted? Of course.

But a commitment will be passed by Congress, and once passed, never again to be denied.

For the first time in my life, a commitment will be made by my country that no American should die for lack of an insurance premium, and that the unlimited medical inflation that threatens our country will begin to end, and that medical treatments must be proven effective.

This will be a commitment, not an achieved goal. But that is how all the important commitments of the US have begun.

So I look forward to a tremendous liberal triumph and a crushing blow to the forces of our increasingly nutty American right.

The GOP, Lieberman, Nelson, and their like will always threaten to ruin progress, and they have limited what we could have done, but they have not stopped us.

For that I am deeply, deeply proud and pleased.

I hope you can join me in this sense of triumph, particularly when the final bill is passed.

Arthur

There is nothing to celebrate this holiday season. We have legislation but not reform. To be considered reform, legislation must:

1. Provide universal coverage regardless of income, employment, or health.

2. Reduce cost.

3. Improve public health.

Neither Senate nor House bills address these goals. Both leave millions of Americans without access to basic health care. Both will contribute hundreds of billions of dollars to private insurance companies with 20% overhead. Neither will improve public health as long as poor Americans must chose between paying for food and paying for health care.

This legislation will make health care worse. It will delay reform. It will exhaust public patience. It will squander momentum developed by organizations such as ours. Worse, it will take a decade and several trillion dollars to discover that this legislation is a failure

I urged my Representative to vote against the House bill. I urged my two Senators to vote against the Senate bill. With all meaningful amendments omitted, we start over.

We cannot let Congress believe that this legislation can substitute for health care reform.

Samuel Metz, MD

Member: PNHP, Mad As Hell Doctors.