Two hundred and thirty-six years ago a small group of brave souls stood up to what was at the time the most powerful nation on earth, declaring their independence from the tyranny of the British Crown. The Sugar Act of 1764, the Stamp Act of 1765, and the Declaratory Act of 1766 (Collectively known as the Townsend Acts) along with the Quartering Act of 1765 and the Tea Act of 1773 all lead to the uprising of the colonies and the American Revolution. Today we are faced with a tyranny of a different sort, which is similarly unacceptable. The Patient Protection and Affordable Care Act of 2010 (Obamacare) has now been upheld by the Supreme Court on a rather thinly veiled technicality. Its not a tax, but its constitutional because it really is a tax. No matter what you call it, this law represents historically the most significant overreach by our own government, and all freedom loving Americans should vigorously oppose it.
As a physician I am privileged to represent the American Society of General Surgeons both as a Delegate to the American Medical Association and as a representative to the Coalition of State Medical and National Specialty Societies; a rather loose consortium of conservative organizations within the AMA, where we’re in the minority to be sure. Following the annual meeting of the AMA House of Delegates in Chicago in June, 2011, we were frustrated by the fact that the House reaffirmed existing AMA policy, supporting a government requirement that every American purchase health insurance, the so-called individual mandate. In the wake of that defeat our Coalition came away without a clear understanding of what our next move should be. Various e-mail threads since then have failed to define a coherent physician-lead strategy. One such series of communications was titled “What is the Battle Plan?” While some would prefer the term Game Plan, either way its clear that we’re talking about a critical contest.
It seems obvious that before any competition one must first determine what is the object of the battle, or game. The problems that exist within the healthcare system are myriad, but central to every argument is one question. Is healthcare a basic human right and therefore the responsibility of government to provide for its citizens, or is it a benefit that has been developed by a civilized society and should be available to those who exercise individual responsibility to obtain it? Not surprisingly this question is quite polarizing, both for healthcare professionals (notice I didn’t use the demeaning term “providers”) and for the public as a whole. This is obviously a complicated issue for which there is no simple answer.
It is ridiculous to imply that American healthcare is bad, as some have claimed. It is the best in the world, but its also the most expensive, and no matter what anyone says, this fact is the sole reason behind the impassioned pleas for reform. Part of the reason our system is so expensive is because there are so many hands in the cookie jar. For years special interest groups have invested heavily in obtaining power within the ranks of government and they were actually the authors of the more than 2,000 page healthcare reform act.
The AMA is often considered to be the doctors’ special interest group, but It is important to recognize that the AMA, and all doctors for that matter, were only peripherally involved in the process of producing Obamacare. AMA leaders were wooed by the White House, but not as potential authors of the new law. Instead they were relegated to the role of commentators. Then during the actual public debate, they inexplicably seemed content just to be at the table, failing to recognize that our profession was indeed the main course. AMA leadership openly supported some elements of the bill, but the public never heard about the parts they objected to. AMA leaders told their dwindling membership (now less than 17% of America’s physicians) that problem areas, like the Independent Payment Advisory Board (IPAB) and the flawed Medicare payment system known as the Sustainable Growth Rate formula (SGR), would be “fixed” when the House and Senate versions came to conference committee. But, as we all found out, aggressive back-room politicians who recognized their opportunity (“If not now, when?”), worked in concert with the giddy media to push the Senate bill through unaltered. In no small way, AMA statements that sounded like doctors supported the bill helped put it on the President’s desk. The total lack of transparency and last minute parliamentary maneuvering made this perhaps the most shameful act of legislative cowardice in American history.
Whether you agree with the concept of universal health insurance or not, (again note I didn’t say universal healthcare because they are clearly not one and the same) the question remains whether it is the role of the government to command it. Patronizing lawmakers have told America’s physicians and our patients that this Congress and this President know what is best for us, and that we’ll like this new system once we get used to the idea. That reminds me of a statement made during a campaign by a gubernatorial candidate in Texas a few years back. He offered this advice to any woman being raped. “As long as it’s inevitable, you might as well lay back and enjoy it.” Well, obviously he lost the election, and based on the results of the 2010 midterm elections, a clear majority of Americans have not yet learned to “enjoy it”, preferring instead to fight back. Many of my fellow physicians have joined in that fight through organizations like the Association of American Physicians and Surgeons and Docs4PatientCare. So to the rest of my colleagues, and to the patients we serve, I would offer the following as a guide for our collective efforts.
- What is the objective of this fight? Repeal the ENTIRE law that we unaffectionately call Obamacare, and start over to create a patient centered system that encourages personal responsibility and rewards individuals for good health practices rather than punishing those who refuse to submit to some government mandate.
- What is the Battle Plan? Practicing physicians must get to work, joining other similarly minded groups and individuals to save our beloved profession. This battle starts with winning the hearts and minds of our fellow physicians. Our message must be that the future of healthcare relies on the individual physician’s moral compass and professional ethics and responsibility, not arbitrary controls mandated by any third party, be they the Federal government or private insurance companies. If we provide clear leadership for those who have lost faith in their representative organizations we will be able to effectively call up the vast militia of practicing physicians to join the fight. They will in turn be able to marshal the support of their patients who intuitively trust their doctors and want us to lead the way.
- What is our first engagement? Our main obstacle to achieving the basic objective of repealing Obamacare is the current uncompromising administration in Washington. Therefore, our primary mission must be to change the current regime. Unlike the Patriots in Philadelphia in the summer of 1776, we can accomplish this change at the polls, but it will not be easy. Between now and November 6, 2012 we must work tirelessly to turn the political tables on those who believe they know what is best for us and all our fellow citizens. There is a true urgency to get to work immediately as the elections are just four months away. Our battle cry in this effort should include that now famous phrase “if not now, when?”
Our God given freedoms and individual rights are like a handful of sand. We don’t lose them all at once; rather they slip through our fingers one grain at a time. The election this coming November has become our final opportunity for “We The People” to declare our independence from a government which openly seeks to control our personal health and individual wellbeing. If we fail in this effort to change the course of this nation now, how can we hope to retain any of our precious few remaining freedoms for ourselves or our posterity.
“The best way to predict your future is to create it.” Abraham Lincoln.
The opinions expressed are my own and do not necessarily reflect those of any organization or group. please feel free to review other posts on www.spiritofhealthcare.com and check out my clinical site at www.robertsewellmd.com