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Address to the House of Delegates

Peter W. Carmel, MD
American Medical Association

American Medical Association
Annual Meeting
Hyatt Regency Chicago
June 16, 2012

Mr. Speaker, Members of the Board, delegates, international guests, colleagues, friends. It is an honor to address this House for the last time as your president.

I thought long and hard about what I would say today. About what the AMA has accomplished over the past year, and the challenges ahead. And I realized that the answer lay no further than my office. The answer lay with my patients.

One of the great gifts of our profession is that our patients always have something to teach us. Lessons you cannot learn from any book. The majority of my patients, of course, are kids. And one of the first things I learned as a pediatric neurosurgeon, is that kids can’t stand being lied to. Even if the truth is ugly, they want to know what’s going on.

Now most children who come into my office are struggling with a life-threatening condition – a tumor, hydrocephalus, or other neurological malady. And the first instinct of a parent, is to protect their child. To tell them, “everything is gonna be okay.”  To tell them, “you’ll be fine.”  Don’t even mention an operation.

Unfortunately, that approach inevitably backfires. Because kids know when things are being kept secret from them. And that makes them insecure.

So I always sit the parents down and advise them not to hide the truth. I remind them that children are smart, and they pick up on every single thing we say. I tell parents the most important thing they can do to prepare a child for surgery, is establish trust.

The amazing thing – the truly remarkable thing – is that when kids learn the truth, they respond with more courage and grace than most adults I know. Understanding the challenge before them, they do not shy away from it. They tend to face it head on, and fight. While victory is far from certain, they believe. And thank God, most often, they win.

There’s a lesson in that for each of us. For all of us.

With exponential change taking place in the health care system it’s easy for physicians to feel threatened. On guard. Even under attack. With all the talk and plans for delivery models, how will small physician practices fit in? With 32 million newly insured patients poised to enter the system, how will we care for them? How can we afford the new health information technology? How can we comply with new quality programs?

These are some of the questions I’ve faced and fielded as I’ve criss-crossed the nation on behalf of our AMA.  Questions that create a cloud of anxiety. And the only thing worse than that anxiety, is the fear many physicians have – the fear that they’re being lied to.

If Congress really wants to improve the health care system, why hasn’t it eliminated SGR? Why hasn’t Congress instituted meaningful medical liability reform? And how can Congress hope to increase quality and accessibility, without supporting the very individuals who provide it?

Believe me, I have several answers to these questions. Involving some choice words.  But back when I was elected president, my wife Jacqueline gave me two rules. She said, “you can’t cuss, and you can’t hit anyone.”

And I thought, “Is this really a job worth having?”

Almost two years later, I can proudly say I never broke the second rule. And I didn’t break the cussing one either . . . at least not in public. So I don’t intend to now.

Instead, I’ll rely on the words of the Greek philosopher, Epictetus, who said, “It's not what happens to you that matters, but how you react to it.”

In the past year, one thing that has really impressed me – how physicians have reacted to the challenges before them. Like the brave patients who come into my office, America’s physicians have risen to the occasion. Rather than close your eyes, pretending that changes aren’t coming to health care, you’ve faced them head on. You’ve sounded your voice on Capitol Hill, in state legislatures, and in courtrooms across the nation.

America’s physicians have stood tall and fought. And together, we’ve scored incredible victories.

As I look back, one triumph stands out above the rest - the progress the AMA has made in shaping new payment and delivery models. When I addressed you last November, I described how AMA advocacy had radically improved the rules for Accountable Care Organizations. How we eased the restrictions, reduced the risk involved, and even convinced CMS to provide $170 million to help physicians with start-up costs.

Since then, these policy improvements have come to life. In April, CMS released a list of 27 newly approved shared savings ACOs.  And amazingly, physicians lead the majority of them. Physicians, not hospitals. Even more amazing, five of these physician-led ACOs are taking advantage of the advance funding advocated for by the AMA.

At this time last year, ACOs appeared all but dead in the water for most physicians. Today, thanks to all of you, ACOs have become a viable option for many physicians. And, this victory sets the tone for the discussion going forward . . . on medical homes, bundled payments, and other models. Thanks to your efforts, “physician-led” has become the guiding principle, both in the public and private sectors.

That’s advocacy in action. That’s physicians making a difference.

Another recent victory is the delay of ICD-10. The AMA heard your fears about the headaches it would cause – the disruption and exorbitant costs. In response, we sent letters to both the House and Senate highlighting the financial and administrative burdens.

And again, miraculously – the government listened! CMS released a proposed rule that not only postpones ICD-10 implementation until November 2014, but also includes regulatory changes that save physicians valuable time and money.

Regarding the AMA’s advocacy on this issue, one DC trade publication said: “Among healthcare industry bodies that lobby, the American Medical Association has few equals. Look no further than the new ICD-10 compliance date for evidence. . .”

The AMA’s clout in Washington – our ability to help shape policy – has been higher this year than at any point in my lifetime.

But our victories don’t stop there. By now, many of you have received your payout from the AMA’s $200 million settlement against UnitedHealth Group. A settlement that sends a strong message to insurers: “You can’t pull the wool over our eyes. You can’t take advantage of America’s patients and physicians.” And the AMA has suits pending against other national insurers too.

We’ve also scored numerous regulatory wins – from eliminating unrealistic lab test order requirements, to protecting you from unreasonable audits. They’re the rules you don’t have time to monitor, full of acronyms and fine print . . . a proposal to extend EMTALA to the inpatient setting, for example. Rest assured that the AMA has been fighting – and winning – on your behalf. So that you can spend less time shuffling papers, and more time caring for patients.

And the AMA has also scored important victories in state legislatures across the nation – 65 this year alone. W

We helped Mississippi, Connecticut, Tennessee, and Utah pass Truth in Advertising legislation . . . ensuring that patients understand the difference between optometrists and ophthalmologists, psychologists and psychiatrists, and chiropractors and orthopedic doctors.

In medical liability reform, we helped North Carolina, Oklahoma and Tennessee achieve caps on non-economic damages.

And in multiple states – Kentucky, Missouri and Louisiana to name a few – the AMA launched a coordinated attack to prevent the Federal Trade Commission from intervening in state licensure issues. To ensure that physicians – not lawyers and bureaucrats – regulate the profession of medicine.

In these cases, and many others, the AMA fought for physician’s rights, and the AMA won.

Of course, not every worthwhile effort results in clear victory. Some of our most important work – such as eliminating SGR – is ongoing. Which brings me to a larger question: where do we go from here?

As you know, there’s a debate taking place in the Supreme Court that will tremendously impact health care. Recently, I reminded the graduates of New Jersey Medical School, that regardless of what happens at the Supreme Court – America’s health care system is already experiencing historic change. As it must.

Let’s not forget that in 2012, more than 50 million Americans lack health insurance. That the United States spends $2.5 trillion each year on health care, yet ranks low in many critical health indices. That chronic conditions have reached epidemic proportions – diabetes, heart disease, obesity and stroke. And that caring for patients with these conditions consumes more than 75 percent of health care dollars.

Continuing down the same path is neither financially tenable, nor ethically tolerable. So where do we go from here? It must be toward a better, more efficient, and more equitable system.

A system where care coordination rules, and where prevention and wellness are prioritized and incentivized.

A system where medical liability no longer adds tens of billions of dollars to health care costs annually, even when 64 percent of claims against physicians are dismissed.

A system that protects graduate medical education, so our next generation of physicians can complete their training.

A system that protects academic medical centers, the safety net where many of those most in need of care – and least able to afford it – turn for help.

A system that can sustain the 72 million baby boomers just entering Medicare.

And a system where the federal government acknowledges that annual physician pay increases of less than one quarter of one percent – year after year, for over a decade – is neither sustainable, nor growing!

We need a system where partisan politics no longer get in the way of doing what is right. Where insurers, hospitals, politicians, and the full spectrum of health care professionals are all working on the same side – the side of the patient!

Colleagues, I have a confession to make. When I graduated from medical school, in 1960, I did not join the AMA. My father, a lifelong AMA member, reprimanded me. He told me I had an obligation to support the profession. But at that time, it wasn’t clear to me what the AMA stood for.

In fact, it wasn’t until 1974, when I heard the young and vigorous new CEO Jim Sammons talk about the importance of protecting patients, and protecting the profession of medicine, that I decided to join the AMA. And since then, the transformation I’ve witnessed has been incredible.

In 1985, when I first served as a delegate to the AMA, I vividly recall attending a luncheon for the specialty societies. And all the specialties, together, could fit around four tables – of eight.

Today, the AMA specialty section is 116 specialties strong, with 201 delegates to this House. Today the AMA includes a Medical Student Section with 47,000 members. And a Resident Fellow Section with 36,000 members. A Minority Affairs Section. An International Medical Graduate Section. A Women Physicians Congress. The list goes on. . . Today, the AMA is the indisputable voice of America’s physicians.

Five years ago, we used that voice to achieve one of the high-water marks in AMA history. We became a voice for the uninsured. (You remember the iconic ad of a patient speaking into a stethoscope.) We highlighted the disparities of America’s health care system, and helped launch the nationwide demand for reform.

The bottom line is that today, because of a conversation that happened right here at the House of Delegates . . .

  • Two point five million young adults under the age of 26 have gained health insurance through their parents.
  • More than 100 million Americans no longer have to worry about lifetime caps on disease coverage.
  • 54 million Americans have already benefitted from expanded coverage for wellness and prevention.
  • And 5.1 million Medicare recipients, have received support to get through the prescription drug “donut hole.”

All of this has already happened – today – regardless of what the Supreme Court decides. That’s physicians making a difference. And I think you’ll agree with me when I say . . . “This ain’t my daddy’s AMA.”

Today the AMA is literally front and center, shaping the future of health care in this nation. As Dr. Madara said, no other physician group has the resources or opportunity of our AMA. No other physician group can have this kind of impact. And with the strategic plan Jim outlined, our impact will grow even greater in the years to come. We will tackle the big issues – the ones that matter most to America’s patients, and America’s physicians. We will lead. We will fight. And I am confident . . . we will win.

Colleagues, a year ago I told you that my heroes – beginning with my father – have always been doctors. Today, I want to draw your attention to one more hero. A mentee of mine, Karin Muraszko. And I have Karin’s permission to share her story with you.

Karin’s childhood was different than most. She was born with spina bifida in 1955, when the medical world understood far less about her condition than we do now. In fact, her parents were told she wouldn’t live – that they should learn to accept it.

But her parents wouldn’t accept it. And neither would Karin. She was determined to fight. Over the years, Karin underwent countless surgeries. While most children were playing in the park, she spent 13 months in a body cast. She learned to walk – not once – but three different times!

Having spent so many days in hospitals, Karin knew by the age of seven that she wanted to be a doctor. And by the time I met her at Columbia University Medical School, she was well on her way . . . extremely bright and tenacious.

But she soon faced a dilemma. During her third year, Karin decided she wanted to become a neurosurgeon. But three obstacles stood in her way. First, she was only four feet nine inches tall, which would make reaching the operating table a challenge. Second, she was a woman, and almost 95% of neurosurgeons are male.

And third, she had a disability. As a result of her spina bifida, one of Karin’s legs is 2 inches shorter than the other. And in neurosurgery, where operations can take 12, 15, even 18 hours, it’s essential that physicians are physically, as well as mentally strong.

While the challenges before Karin were great, her determination was even greater. I told her that she was going to have to prove herself – even “over-prove” herself to achieve her goal.

I knew she could.  I knew she would. And of course . . . she did!

Karin shadowed me and other neurosurgeons, demonstrating her ability to meet the physical demands. She received honors in all clinical rotations and superior Board scores.
By the time she graduated, she was second in her medical school class, and she became the first disabled person to enter Columbia’s neurosurgical residency program.

Since then, Karin has never looked back. When she couldn’t reach the operating table, we had a device constructed to raise her up.When she met with sexism or prejudice, she fought to overcome them.

Today Dr. Karin Muraszko is the Chair of Neurosurgery at the University of Michigan, the first – and only – woman to chair a neurosurgical department in the nation. Karin embodies our will to fight. She is an inspiration to her colleagues, and a lifesaver to the nearly 400 children she sees each year.

My fellow AMA members, as we push forward to reform America’s health care system, there’s no question that it will be hard. And as we look to the future, the challenges are great.

But the opportunities, are even greater. And if there’s one thing physicians have in common – whether we’re neurosurgeons or pediatricians, Republicans or Democrats – It’s the courage and the conviction to fight!

We were born to fight. We were trained to fight. We fight for the lives of our patients every day.

Thank you for giving me the opportunity to lead our charge this past year. It is an honor for which I am forever grateful. And I look forward to continuing that fight in the years ahead . . .standing right alongside you, my fellow physicians, my heroes.

Thank you!