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AMA President-Elect Discusses Health Care Reform

Sept. 16, 2009

Center for Global Health and Medical Diplomacy
Third Annual Caring Community Conference
Jacksonville, Fla.

Cecil B. Wilson, MD
American Medical Association

Thank you for the opportunity to be here to talk about health system reform and the AMA’s hope for the outcome.

It is an honor to be asked to speak here once again, at the invitation of a dear friend and long-time colleague – Dr. Coble, when he became the AMA President, said in his inaugural address “adversity can be more than just an inventory of problems.  Adversity can be a force for positive change.”

Today, our nation is facing adversity – but not the adversity you might think of.

Some might think that the adversity is Democrat versus Republican.

Liberals versus conservatives.

Progressives versus Moderates.

Blue Dogs versus Red States.

Well, I’d like to encourage a different point of view.

I’d like to point our attention beyond the rhetoric that fills up talk show radio and the blogosphere.

This afternoon, I’d like to discuss what’s truly at stake – the health of America.

Or to be more specific, the health of America’s patients.

Sir William Osler, a favorite of Dr. Coble, and mine, has often been called the father of modern medicine. Dr. Osler once said, "caring is the most important thing to do – so do it first."

But for more than 46 million of us who are without health insurance, health care is beyond our reach; 46 million of our friends and neighbors do not have access to care that the rest of us rely on to prevent sickness and disease; to treat chronic conditions before they become acute.

Here, in the finest country in the world, 46 million of us are making decisions that those with insurance simply are not forced to make.

Here, in the United States, 46 million of us are living sicker and dying younger, and that, in no uncertain terms, is a black-eye for our country.

Last week, the AMA sent an open letter to Congress and the President emphasizing our principles for effective reform.

I don’t have time to go into each aspect, so let me highlight the areas on which there should be no disagreement.

Congress has an historic opportunity to improve the health and well being of the American public.

We all need to remind them that they need to put aside partisan politics and act for the nation’s future.

They need our encouragement.

Mark Twain once said, “Everybody talks about the weather but nobody does anything about it.

The AMA is doing something about moving health system reform in the right direction by emphasizing what we all agree upon.

First – Provide health insurance coverage for all Americans.

Second – Enact insurance market reforms that expand choice of affordable coverage and eliminate denials for pre-existing conditions.

And third – Ensure that health care decisions are made by patients and their physicians, not by insurance companies or government officials.

We are at the table every day working with Congress to help them get the job done.

But we cannot do it alone.

There are other, more analytic reasons to support reforming the system.

Increasing costs are outstripping inflation.

Health care costs are currently consuming more than 2 trillion dollars each year almost one-fifth of the entire U.S. economy; headed for 4.4 trillion annually in ten years if nothing is done.

Some might ask whether our nation can afford to pay for reform, which reminds me of an ancient Chinese proverb:

“When is the best time to plant a tree,” asked the boy, sitting in the hot sun with his teacher.

“Twenty years ago,” replied the teacher.

The young boy, feeling the sweat run down his cheeks, then asked, “Well, then when is the second best time?”

“Now,” replied the teacher.

Ladies and gentlemen, we have been at this for more than 75 years.

Presidents going back to FDR, Truman and Eisenhower have tried.

Now is the right time to reform the system, or surely the health care desert will consume many more millions of our friends and neighbors.

Needless to say, there are a few misconceptions floating out there about what is under discussion.

And while that makes the job of reform more difficult, it also highlights why it’s critical that we emphasize what is actually happening in Congress.

Let me highlight the main options that the House and Senate are discussing.

First, in the House there are Medicare reforms that will help protect seniors’ access to care.

This includes reimbursements that encourage preventive care.

This includes incentives to help hold down costs without affecting quality.

It includes increased support for prevention and wellness services, as well as making investments in the physician workforce.

It does not include “pulling the plug on grandma.”

It does not include government telling doctors what to do.

It does not include doctors being handcuffed in treating our patients.

The AMA would never stand for that.

In the discussion, there also is support for a regulatory framework for health insurance coverage that the AMA has long supported.

We don’t want to see an end to private health insurance – far from it.

We do, however, want to see some common-sense regulations that bring fairness to the system for patients and physicians. 

We want to see an end to insurance coverage denials based on pre-existing conditions.

We want to see burdensome regulations and administrative nightmares take a back seat to effective patient care – care directed by physicians, not bureaucrats.

We want to see additional support for primary care without reductions in non-primary care.

And we’re looking closely at the idea of the health insurance exchange.

Will it as promised provide a choice of plans to the uninsured, self-insured and small business employees?

Would there be voluntary physician participation?

Will it be economically self-sufficient?

Suffice to say, there is a lot of information being reported.

There is a 1,000-page piece of legislation being closely scrutinized.

There are many other provisions under discussion.

Nothing is final, but one thing is certain – the status quo is hurting our nation.

Keep in mind that the road to the White House for a final bill is long and has many detours and blind alleys.

The action in the House and the negotiations under way in the Senate are part of the process.

As the Beatles would say, “It’s a long and winding road.”

And along that road, there has been a lot of strong emotion.


Health care is intensely personal.

And it should be.

But we have to be careful not to become distracted by misinformation or efforts to scuttle debate just for the sake of scuttling reform.

And we must not let our fears about the future paralyze us into doing nothing.

There’s too much at stake.

Which is why it’s critical that we emphasize what we are for; and why the AMA remains a constructive player forcefully and faithfully representing America’s physicians.

And to that point, reasonable people can disagree reasonably.

The AMA has worked for more than two years to get to the point where we have a chief seat at the table.

We’re there because we have relied on our foundational principles to advocate for patients and physicians.

And that means listening to the options.

It means acknowledging that we might not get every single thing we may want, but overall, the nation’s patients and physicians will gain important benefits in the process.

Today, right now, physicians, and all of us, have an opportunity and responsibility to help shape the outcome of health system reform.

We have an opportunity that may not come around again for decades.

We have a responsibility to make sure we make the most of this opportunity – for ourselves, and for our nation.

Thank you again for the opportunity to be here.

I look forward to your questions.