Last weeks massive protests in Iran brought to mind a pronouncement from the eminent healthcare economist Victor Fuchs: The U.S. will see major healthcare reform only in the wake of a war, a large-scale recession or large-scale civil unrest.
Cats still in the bag ...
... but things could get ugly if it gets out that revenue is prime motivator
Fuchs may be optimistic. After all, we now have two wars and the most severe economic downturn since the Great Depression, and the prospects of meaningful reform, given balking special interests, still seem remote. Civil unrest might complete the hat trick, but Americans at the moment are confused about healthcare, shell-shocked by the recession and, so far, docile.
The tranquility would evaporate if Americans knew how their physical and financial well-being has been compromised by some industry groups. One of the key players in this long-running tragedy has been the American Medical Association. The organizations efforts to thwart major reforms and preserve the status quo stretch back to the early part of the last century.
It popularized the term socialized medicine, and, nearly two decades after the end of the Cold War, its members are still employing Red Scare tactics to drive the masses away from anything perceived as detrimental to physician income.
So when President Barack Obama spoke before the AMAs House of Delegates last week, he arguably faced a greater challenge than the Iranians trying to overturn an illegitimate election. The AMA didnt exactly throw rose petals on his path to the conference. The week before, the AMA, which detests Medicare payment levels, let it be known in Washington that it didnt favor a public health plan as an option for the uninsured. Then, realizing it had made a social blunder in advance of a presidential speech pitching that option, the AMA declared that its position had been distorted by the New York Times.
The president was politely received by the AMA crowd and received several standing ovations. He also was booed when he told delegates that while he was open to some malpractice cost remedies, he didnt support caps on damages.
Late the next day, some delegates couldnt wait to rip into the public plan proposal. Cooler heads in leadershipmainly outgoing President Nancy Nielsenprevailed and an in-your-face resolution was watered down to express general support for reform in line with AMA principles.
Thus, the AMA did its version of Michael Jacksons moonwalk: appearing to move forward while actually remaining in place.
In the meantime, the AMAs most militant anti-reform members should clear the June 1 issue of the New Yorker from their waiting rooms. There, patients could read an article by physician/author Atul Gawande focusing on McAllen, Texas, as a lesson in whats wrong with the nations healthcare. The article has become required reading in the Obama administration.
It dwells on costs and contains this eloquent statement about systemic dysfunction: When you look across the spectrum from Grand Junction to McAllenand the almost threefold difference in the costs of careyou come to realize that we are witnessing a battle for the soul of American medicine. Somewhere in the U.S. at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor. And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.
If Americans ever fully realize that too much of the system is aimed first and foremost at maximizing revenue for a few rather than improving the welfare of the many, the streets of Washington might be as full as those of Tehran.
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