Designing a bridge to a better health care system

This column was originally published in AMA eVoice on June 19, 2008. Dr. Nielsen is president of the American Medical Association.

I'd like for you to think for a moment about bridges. All kinds of bridges. Close your eyes and picture the Golden Gate bridge, the Brooklyn bridge, a covered bridge in rural America, the Ponte Vecchio, the London Bridge.

They all have one thing in common—they bridge from here to there, across a gap or over an obstacle. They represent human greatness and ingenuity, because at some point in time there was no bridge there—only the chasm, the river or the obstacle. Then some group grew tired of the obstruction, took the initiative and built a bridge.

I believe there's an important analogy between bridges that withstand high winds and stormy weather to provide safe passage across a chasm, and our opportunity to change our nation's health care system.

Today's physicians face many obstacles. We work harder and harder, but we face reimbursements that are flat or worse while practice costs go up. We're forced to spend less time with our patients, who have increasingly complex conditions and concerns. Information explosion and advances in technology challenge all of us to keep up our knowledge and skills. We came to medicine to care, to cure, to comfort. But these values are often not reflected in payment systems.

We stand like surveyors at the edge of a very large chasm in health care, facing a challenging and sometimes hostile environment. So what do we do? Do we fight, storm the barricades, hunker down, dig a moat around us to stave off invaders? Should we despair?

Henry Kissinger once said, "The statesman's duty is to bridge the gap between experience and vision." So why not turn this problem into an opportunity? Why not take up tools to build a signature bridge for America over this chasm in health care? Why not, like a civil engineer, start weaving wires into cables and join patients, employers and maybe even insurers to build a bridge to a better future, where the real enemies are disease, despair, and untimely death?

Let us agree to lead. Let us come together to agree on national health care goals and a timetable to reach them. Then the bridge-building can begin.

One issue that sorely needs our leadership is the problem of America's uninsured. It is unconscionable that thousands of patients die each year because they delay care until it is too late. In my year as president I will use all of the power of this office, and of the AMA, to give a voice to those patients, to let the nation know that we must cover the uninsured.

Calling attention to the problem is simply not enough. It's time to design and build a solution—and to figure out how to pay for it. And it's time to recognize that each of us should be able to purchase affordable health insurance, not be pawns of an employer's choices. We must work together to build that bridge with the common goals of coverage and choice, combined with care and compassion.

Regardless of our political leanings, we simply cannot allow the problem of the uninsured to grow ever larger. To do so in this time of economic downturn would be a national tragedy. So let us lay down arms, take up tools and build a bridge. Not a pork-barrel "bridge to nowhere." Our bridge has got to go somewhere.

We must work with others—patients, employers, maybe even insurers—if they participate in good faith. We're going to differ on tactics, but the goal must be clear. We're going to differ on details, but let us accept the shared responsibility to do what is right, what is ethical and what is necessary.

To make rapid progress, while awaiting a new president and Congress, let's come together with others to figure out how much innovation can be undertaken quickly, without legislation. I will be the first to tell you that this will not be easy. And it's not without risk. But physicians work with risk every day.

Now is the time for us to step forward, lead and design that bridge. We can build it strong and beautiful—and with devotion. We know the problems better than anyone. Let's be the civil engineers who design the solutions that transform health care for the better.

Please send comments, questions, and replies to amaprez@ama-assn.org.