Why I Went to Washington: The Importance of Physician Voices in the Health Care Reform Debate
Nathan Bahr, MD, MA
In October, I was lucky enough to be one of about 150 physicians present as President Barack Obama addressed health care reform in the rose garden of the White House. As Minnesota’s state director for Doctors for America, a grass roots organization with more than 15,000 physician members throughout the United States, I’ve been actively pushing for reforms that would make health care coverage more affordable, expand access to care, improve the quality of care, and support practice environments that allow physicians to focus on patient care rather than administration and paperwork. I was invited to the event by the White House because the voices of physicians are being heard in Washington. Our organization, along with a number of other physician groups, hasn’t been shy about making our preferences known when it comes to health care reform.
I went to the event because I think it’s important for our patients and our legislators to know that doctors realize that it is time for our health care system to change and that the majority of physicians support progressive health reform. I want it known that doctors see health care reform as a patient care issue—that they care more about their patients than their paychecks. I also went because the event was a chance to meet physicians from around the country who are also fighting for a better health care system. Although there is agreement about many of the reform measures that are being discussed in the House and Senate, the inclusion of a number of crucial measures seems less certain. I believe two of these measures could make a big difference in the lives of our patients and in holding down the cost of care.
The most publicized of these is a public insurance option. A public option would benefit patients and the entire health care industry; it would drive competition that would force insurers to lower the cost of premiums for patients and offer better products. I see the inclusion of a public option as crucial to the effectiveness of health care reform. I don’t think I’m alone in my view. Keyhani and Federman’s survey of nearly 5,000 physicians, which was published in the New England Journal of Medicine on October 1, found 62.9 percent of physicians surveyed supported having both public and private health insurance options.
Without effective competition among insurers, the insurance mandates that are being discussed would effectively lead to little more than increased profits for insurance companies without any assurances of better-quality care or lower premiums for consumers. This issue is particularly important in parts of the country where one or two insurers currently dominate the market. As noted in the AMA’s 2008 update on competition in the health insurance market, a handful of insurers have a lock on far too many markets. If an alternative proposal were brought forth that would provide actual competition, I would happily support that proposal as well. However, at this point, the only suggestion that would provide the necessary competition is the public option.
Another issue that needs to be addressed immediately is the incredibly high cost of medications. The House Energy and Commerce Committee has proposed requiring the Health and Human Service Secretary to negotiate directly with pharmaceutical companies to lower drug prices for Medicare Part D plans and Medicare Advantage Part D plans. This proposal is long overdue and necessary. We’re sadly unique among industrialized countries in that we don’t allow our government to negotiate directly with pharmaceutical companies; and we pay for it. This provision has the potential to provide significant savings.
Whatever bill comes out of the health care reform debates will not be a final fix for each and every ill of our health care system, but it will be a good start. And although physicians’ opinions vary on the direction that health care reform should take, we can all agree that our current system is broken and in need of drastic change. We face issues each day that seem to have very little to do with the oath we took as physicians and more to do with the business of health care. It’s time that inefficiencies and paperwork were replaced by a system of efficient, high-quality health care delivery.
As physicians, we all have a duty to our patients. We took an oath that we would strive to provide the best care possible to our patients. In my opinion, unless I am pushing for real change to our health care delivery system, I am not doing my best to honor that oath. As physicians, we have a unique obligation and opportunity to influence policy that will positively affect the health of our patients. We need to speak out now so that we will be in a better position to offer the kind of care that we strive to deliver. Health care reform is ultimately about helping patients—that’s why I went to Washington, and why I continue to work on these issues.
Nathan Bahr is an internal medicine resident at the University of Minnesota and the Minnesota State Director for Doctors for America.