Patients' rights efforts are good medicine

AMA Leader Commentary. By D. Ted Lewers, MD. Jan. 1/8, 2001.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from D. Ted Lewers, MD, chair of the AMA Board of Trustees.

This month, the 107th Congress, for the first time since last year's amazing and historic election, is going about the business of legislating this country's challenging and complex affairs. Like many of you, I've listened to the prognosticators discuss how this Congress may be marked by contention and acrimony, and how thoughtful debate and proactive legislation can be derailed by partisan bickering.

I'm more optimistic than that, though, because when the physician community comes together, we have the influence and ability to break through the partisan roadblocks and build the foundation for strong patients' rights and strong physicians' rights. Last year, we made significant progress on both fronts, learned important lessons and built strategic footholds. This year, we already are working hard to deliver the results you and your patients have asked for.

Our fight to pass a real patients' bill of rights has been a long and hard fight, but we're closer than ever. With your help, in 1999, we built a bipartisan congressional majority seldom seen in Washington. After years of AMA advocacy, 275 members of the U.S. House passed what is known as the Norwood-Dingell Patients' Bill of Rights.

The nation's news media called our work "historic." We agree, not the least because of the success of our grassroots AMA National House Call campaign to build public support for our advocacy.

As a result, just a few months ago, a majority of senators courageously stood with the AMA and were prepared to vote for the only bill that provides physicians and patients the rights they deserve:

The right for doctors to decide what is medically necessary.
The right for patients to have an independent, timely and fair external appeal if a health plan decides to delay or deny care.
The right for patients to hold health plans accountable when their decisions harm patients.

Unfortunately, the bill never came to a vote in the Senate. The HMOs' $100 million distortion campaign prevailed with congressional leaders who blocked every effort to bring our bill to a Senate vote. Plainly put, they succeeded in defying the will of the people. But that was last year. This year, we are hopeful that our bipartisan efforts will finally bear fruit.

What makes me confident is that our fight is sound medical policy, sound political policy and most of all, sound public policy. It is good medicine. It is good medicine for physicians, good medicine for our patients, good medicine for our country.

Standing together, though, is what our opponents don't want us to do. They would rather take leaders of organized medicine -- one by one -- into their conference rooms and dictate to us what profit-driven underwriters think is appropriate patient care -- and appropriate levels of quality.

We want the 107th Congress to know that physicians must have the right to band together to stand up to unreasonable rules and restrictions. Physicians must have the right to be the ones making decisions about their patients' health care needs.

The physician antitrust bill championed by Rep. Tom Campbell (R, Calif.) in the 106th Congress would have given physicians those rights. It also included something more -- the strength of law, which is abundantly needed in today's era of managed care consolidation. Since 1994, there have been more than 250 mergers and acquisitions of health plans.

Today, just seven powerful plans -- plus the Blues -- control the cost, access and quality of care for most Americans. In this case, seven is anything but a lucky number. Those plans fought tooth and nail to defeat the Campbell bill. Their political operatives introduced "poison pill" legislation to kill the bill's chances, but we were not going to be denied.

We worked the phones, fired off e-mail and helped many of you get in touch with your representatives.

Together, we told them how health plans believe the least costly medical care is the best care. We told them how case managers are making patient care decisions over the phone. We told them federal law was necessary because patients' health was being determined by the bottom line and that's not what we were taught in medical school. We told them our experiences. We worked together and won round one.

In the early morning hours of June 30, 2000, the AMA held its ground against Big Insurance as the Campbell bill passed the House of Representatives by a 276-136 final vote. Lawmakers recognized what physicians know -- it's time to level the playing field and give us the right to advocate for our patients and for ourselves. And although the Campbell legislation stalled in the Senate, we already are working with the new Senate to move this important antitrust legislation forward.

But we all know more work needs to be done. As chair of your AMA, I assure you that we will neither rest nor retreat. Our advocacy on your behalf will not relent until we succeed. Our patients' and our profession's health depends on it.

Tell me what you think. E-mail me.

Dr. Lewers of Easton, Md., a nephrologist and internist, was AMA board chair during 2000-01.