Grap­pling with a le­viathan

Right to con­tract pro­vides needed coun­ter­bal­ance to govern­ment power in health­care The re­form law has given the fed­eral govern­ment too much power over health­care de­ci­sions.

Modern Healthcare - - Opinions Commentary - M. Todd Wil­liamson

The Coali­tion of State Med­i­cal and Na­tional Spe­cialty So­ci­eties—which rep­re­sents more than 85,000 physi­cians—does not be­lieve that the new health re­form law is what’s best for pa­tients and physi­cians.

The coali­tion in­cludes the Med­i­cal As­so­ci­a­tion of the State of Alabama, the Med­i­cal So­ci­ety of Delaware, the Med­i­cal So­ci­ety of the District of Columbia, the Florida Med­i­cal As­so­ci­a­tion, the Med­i­cal As­so­ci­a­tion of Ge­or­gia, the Kansas Med­i­cal So­ci­ety, the Louisiana State Med­i­cal So­ci­ety, the Med­i­cal So­ci­ety of New Jersey, the Mis­sis­sippi State Med­i­cal As­so­ci­a­tion, the South Carolina Med­i­cal As­so­ci­a­tion, and the Ten­nessee Med­i­cal As­so­ci­a­tion. It also in­cludes the Amer­i­can Academy of Fa­cial Plas­tic and Re­con­struc­tive Surgery, the Amer­i­can As­so­ci­a­tion of Neu­ro­log­i­cal Sur­geons, the Amer­i­can So­ci­ety of Gen­eral Sur­geons, and the Congress of Neu­ro­log­i­cal Sur­geons. And it in­cludes three for­mer pres­i­dents of the Amer­i­can Med­i­cal As­so­ci­a­tion— Daniel John­son Jr., Don­ald Palmisano and Wil­liam Plested III.

We col­lec­tively be­lieve that the Pa­tient Pro­tec­tion and Af­ford­able Care Act has given the fed­eral govern­ment too much power when it comes to the de­ci­sions that are made sur­round­ing our health­care. What’s more, it is not fi­nan­cially sus­tain­able.

We are con­vinced that a crit­i­cal mass of the rank-and-file physi­cians who prac­tice medicine in this coun­try—across both geo­graphic and spe­cialty lines—share our be­lief that the key to pre­serv­ing pa­tient ac­cess to care is re­form­ing the nation’s med­i­cal pay­ment sys­tem, which is a mes­sage we have been de­liv­er­ing to as many stake­hold­ers as pos­si­ble for a year and a half now.

As the largest govern­ment-run health­care pro­gram, Medi­care rep­re­sents a glar­ing ex­am­ple of the need for change. It is be­com­ing in­creas­ingly dif­fi­cult for physi­cians to ac­cept Medi­care pa­tients as a sim­ple eco­nomic mat­ter as the gap be­tween pay­ment rates and the cost of run­ning a prac­tice grows wider.

The good news is that, at our urg­ing, the AMA House of Del­e­gates took an im­por­tant step in the right di­rec­tion when it passed a res­o­lu­tion dur­ing its meet­ing in Chicago in June with over­whelm­ing sup­port that read:

“Re­solved, that our Amer­i­can Med­i­cal As­so­ci­a­tion im­me­di­ately for­mu­late leg­is­la­tion for an ad­di­tional pay­ment op­tion in Medi­care fee-for-ser­vice that al­lows pa­tients and physi­cians to freely con­tract, with­out penalty to ei­ther party, for a fee that dif­fers from the Medi­care pay­ment sched­ule and in a man­ner that does not for­feit ben­e­fits oth­er­wise avail­able to the pa­tient. This leg­isla­tive lan­guage shall be avail­able to our AMA mem­bers no later than Sept. 30, 2010.”

We be­lieve that pa­tients and physi­cians should be free to pri­vately con­tract with­out bureau­cratic in­ter­fer­ence or penalty. This change would em­power pa­tients as they make im­por­tant health­care de­ci­sions, in­clud­ing the source and cost of their med­i­cal care.

Pri­vate con­tract­ing—which is a touch­stone of Amer­i­can free­dom and lib­erty—is the only re­al­is­tic way that we can achieve bud­get cer­tainty while re­main­ing free of the heavy hand of govern­ment (e.g., de­cid­ing who gets health­care and how they are treated and at what cost).

And be­cause it’s a free-mar­ket busi­ness model that by­passes price con­trols, the right to con­tract will ad­dress the nation’s grow­ing physi­cian short­age in an or­ganic way by cre­at­ing a more fa­vor­able and sus­tain­able prac­tice en­vi­ron­ment.

In­di­vid­ual pa­tients should be free to spend their own money on their own med­i­cal care as they see fit—re­gard­less of third­party pay­ers. Un­for­tu­nately, that’s not a given with govern­ment-run pro­grams such as Medi­care, which gen­er­ally dic­tate treat­ment and pay­ment terms.

We be­lieve that we can close the di­vide be­tween govern­ment pro­grams and the real cost of health­care by restor­ing the pa­tient’s right to pri­vately con­tract with his or her physi­cian us­ing the pa­tient’s in­di­vid­ual cir­cum­stances as the base­line for that dis­cus­sion.

We are res­o­lute in our be­lief that the right to con­tract pro­vides the op­ti­mum rem­edy. It is a sus­tain­able and pa­tient-cen­tered so­lu­tion for the med­i­cal pay­ment sys­tem that will en­sure that Amer­i­cans have ac­cess to the physi­cians they want to see in their hour of need. More­over, it serves as a ra­tio­nal model for ev­ery third-party pay­ment sys­tem.

The mem­bers of the coali­tion fur­ther be­lieve that the de­ter­mi­na­tion of the qual­ity of med­i­cal care must be made by the pro­fes­sion of medicine—not by the govern­ment or other third-party pay­ers. We also be­lieve that Med­i­cal li­a­bil­ity re­form that’s based on proven poli­cies is an es­sen­tial part of any health­care re­form.

These are the key prin­ci­ples that we be­lieve will help en­sure that Amer­i­cans have ac­cess to qual­ity health­care that’s af­ford­able. And that ul­ti­mately means that they will en­joy greater safety and se­cu­rity and peace of mind.

M. Todd Wil­liamson, a neu­rol­o­gist, is the spokesman for the Coali­tion of State Med­i­cal and Na­tional Spe­cialty So­ci­eties and the im­me­di­ate past pres­i­dent of the Med­i­cal As­so­ci­a­tion of Ge­or­gia.

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