The state of the union -- and of the nation's health

AMA Leader Commentary. By Duane M. Cady, MD, March 6, 2006.

AMA LEADER COMMENTARY

A few words about current events in medical practice

SEE ARCHIVES

A message to all physicians from Duane M Cady, MD, chair of the AMA Board of Trustees.

In his recent State of the Union address, President Bush mentioned several issues related to health care, medicine and the uninsured that are also key priorities of the American Medical Association.

Topic: Liability crisis

In his speech, he cited the importance of "strengthening the doctor-patient relationship." It is our hope that his remarks will spur further dialogue about the health care issues that impact all Americans.

This passage in particular outlined some of what we may see in the year ahead in the realms of medical and health care policy:

"We will strengthen health savings accounts, making sure individuals and small-business employees can buy insurance with the same advantages that people working for big businesses now get," the president said. "We will do more to make this coverage portable, so workers can switch jobs without having to worry about losing their health insurance."

Access to quality medical care is a central element of this issue. One way to ensure access is to make sure more people have health insurance, while not bankrupting the health care system in the process.

The rising cost of care is a growing concern in this country. The AMA believes that we must engage patients as partners to manage costs successfully and achieve greater value from the resources devoted to health care.

Consumer-driven health care encourages patients to take a greater interest in their health care and how they spend their health care dollars by putting themselves in the driver's seat.

The AMA believes that health savings accounts empower patients to have greater control over their health care decision-making and are an important choice in the health insurance mix. Coverage choices such as HSAs provide flexibility and portability for patients, allowing them to change jobs without worry.

With HSAs, consumers deposit their own money into special accounts -- sometimes with contributions from employers. That money, which does not count as taxable income, can be used to pay for routine medical costs. Monthly premiums are lower than more comprehensive plans because they're aimed at catastrophic coverage.

In his State of the Union remarks, Bush also addressed another issue with repercussions for patient access to care -- the medical liability crisis.

"And because lawsuits are driving many good doctors out of practice -- leaving women in nearly 1,500 American counties without a single ob-gyn -- I ask the Congress to pass medical liability reform this year," he said.

Meaningful medical liability reform is another goal the AMA shares, and we applaud President Bush for again calling on Congress to pass such reforms this year. Multiple polls show that nearly three-quarters of Americans support passage of medical liability reforms.

In addition to efforts to insure the uninsured and for medical liability reform, the AMA's advocacy agenda for 2006 includes Medicare physician payment reform, public health improvements, quality improvements and managed care reform.

And right now, the AMA is working to help smooth implementation of the new prescription drug plan.

The AMA launched a working group last summer with physician, pharmacist and patient organizations to develop tools to help expedite patients' access to needed medications. And those medications are needed -- four out of 10 seniors take five or more prescription drugs.

We are working together to streamline communication between physicians and pharmacists to help patients get the drugs prescribed by their doctors and save money with the new Medicare drug benefit.

The working group developed a form that pharmacists can use to inform physicians of issues with drug plan coverage policies and to let physicians know if alternate medications are available at lower cost to the patient. This form is posted on Web sites for the AMA, the Centers for Medicare & Medicaid Services and other groups for easy access by physicians and pharmacists.

Physicians consider many factors in selecting drug therapies for their patients. They want to get maximum benefit and minimize problems such as drug interactions, side effects and allergic reactions.

To avoid complications from changes in medication, physicians might need to seek exceptions for these patients. The form also will help some patients pay lower co-pays for a drug they need when a substitute won't work.

Medicare officials have told the AMA that many of the initial computer system failures have been resolved, and any low-income patients who were inappropriately required to pay deductibles or excessive co-payments now can be reimbursed by their drug plan.

Many seniors are still deciding whether to enroll, especially in the wake of the growing pains during the benefit's launch.

Toward that end, the AMA is urging the administration to require that drug plans provide an additional two months of transitional assistance to patients as an investment in the long-term success of the program.

The AMA looks forward to working with the administration and Congress on these issues -- and others -- to improve the nation's health care system.

Dr. Cady, a general surgeon who was in private practice for 35 years in Syracuse, N.Y., was chair of the AMA Board of Trustees during 2005-06.