Call for Unity

Today’s health care reform vote on Capitol Hill, while high drama, really only signals the beginning of the work that needs to be done by emergency physicians to improve access to emergency care for our patients and future patients. As I write this, I am watching the floor deliberations via the miracle of technology, and I know that the outcome will disappoint 48% of ACEP members, 48% of all physicians, and 48% of the American public, if polls are to be believed......and that will occur regardless of the outcome.

The greatness of our democracy lies in the ability of our people to freely elect their government representatives and to express themselves fully in the debate over crucial issues. Never in my lifetime has this been more apparent than during the health care reform debate. I believe that almost everyone has an opinion on health care, including many non-Americans, and almost everyone has expressed that opinion at some point.

The real challenge to our democracy, to our specialty, and to our organization is to move forward once today’s vote has been taken. We must have great care not to fall victim to Jefferson’s “tyranny of the minority.” We must move forward to create the greatest health care system in the world, befitting the greatest nation in the world, no matter the outcome of today’s vote.

There is no “win” today for emergency medicine. There is only new illumination on the path to achieving better emergency care. The real work comes as we identify areas that need our skills in innovation and problem-solving and get to work shoring up the nation’s emergency care system. My fervent wish is that emergency physicians will find a common bond in the needs of our patients, and put the rancor and division of the path to health care reform behind us in the interest of better emergency care for everyone.

Personal thoughts on DC's latest

Just want to share a few thoughts with you ......

First - Take a deep breath.

Next - Remember the reason that health reform is being debated. The present system is NOT SUSTAINABLE. The status quo is not an option because the status quo cannot continue unchanged. The most generous optimists project that government sponsored health programs will be completely depleted by 2017.

As for what is going on in D.C., here are the latest options being discussed, along with my personal (editorial) comments:

1.) Include persons between 55 and 64 in the Medicare program.

Does this include everyone between the ages of 55 and 64, or just those who cannot obtain employer-sponsored coverage?

Does this mean that reimbursement will be at Medicare rates or at another rate?

2.) Private insurers would be required to spend 90% of premiums on clinical services and programs to improve care.

The obvious answer to this for insurers is to increase premiums so that the bottom line remains the same.

3.) The Office of Personnel Management, which currently oversees health policies for federal employees, would manage a new system of national health plans available in every state to people who do not receive coverage through their employer.

Absent from this discussion is the personal mandate. As I see it, there is no way increase the risk pool. In addition, there would need to be a considerable ramp-up of the OPM.

4.) The Office of Personnel Management would be empowered to negotiate rates with insurers.

OK. This is better than the House bill? This "renames" the public option and puts it squarely in the Executive sector, beyond the control of the Legislative Branch. Hmmmm..

5.) Buried in there somewhere is a "trigger" for the public option.

I am unable to verify the existence of this "trigger," so will refrain from comment.

This is a piecemeal approach to a public option, and much like Frankenstein, may exceed the expectations of the creators.

Lastly - What happens next is that CBO will have to score the various options. (Insiders say that several different combinations were sent for scoring.) That may take a week. In the meantime, Reid is looking for cloture on the manager's amendment, which includes compromises he has worked on for the past 10 days. Other cloture votes will be required subsequently. More concerning to me than all the above is the rumor that if the Senate is unable to reach an agreement by the end of the year, the Democrats would push for bypassing a conference bill and call for a direct endorsement of the House bill.

Just a few thoughts to help you sleep tonight,

Angela (Angela F. Gardner, MD, FACEP)

PS Discussions continue on an amendment that would allow direct importation of drugs from countries approved by the FDA. Obviously Pharma opposes.......but the savings could be immense.