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Viewpoint: A historic, long overdue first step

AMA's view on healthcare reform and next steps



J. James Rohack, MD
Our country recently took a historic and long overdue step toward health system reform. While the new law is not perfect, this sweeping reform package will greatly benefit patients and their physicians.

Few issues have sparked such heated debate as healthcare reform, and while there has been widespread agreement that the status quo is unacceptable and that we need reform, opinions on what to do about it have been conflicting. Throughout the process, the AMA, guided by its House of Delegates, remained actively engaged in an effort to ensure that the physician voice was heard.

We worked closely with lawmakers from both sides of the aisle, the administration, and our physician colleagues to communicate what we felt was best for patients, physicians and the medical profession as a whole. Some provisions of the bill signed into law will need to be changed, but on balance we believe it signifies an important step forward on the journey toward an improved American healthcare system.

The healthcare reform package extends health coverage to more than 30 million uninsured, improves competition and choice in the insurance market, promotes prevention and wellness, reduces administrative burdens, and promotes clinical comparative effectiveness research. There are increased payments for primary care physicians caring for Medicare and Medicaid patients and bonus payments for primary care physicians and general surgeons in underserved areas. It also acknowledges that the current medical liability system is broken and provides funding to test reforms such as health courts and early disclosure laws. This is not the proven medical liability reform physicians and the AMA wanted, but it is more than we've achieved on this critical issue at the federal level in the past, and indicates that legislators are beginning to understand the impact that liability exposure has on escalating healthcare costs.

The AMA raised concerns during the healthcare reform debate about a number of proposals that ultimately were not included in the final bill. Those items are:

  • no proposed Medicare and Medicaid enrollment fees for physicians;
  • no proposed 5 percent cut to physicians identified as outliers;
  • no proposed payment cuts for specialty care services to fund primary care increases; and
  • no proposed tax on elective cosmetic surgery and medical procedures.

As we move forward, there are still some important measures that need to be addressed. Congress must act to permanently repeal the broken Medicare physician payment formula that threatens steep cuts to physicians for the care of seniors and military families. Another Band-Aid fix will do nothing for physicians struggling to keep their doors open to Medicare patients, and only grows the cost of a permanent solution for taxpayers.

Changes also need to be made to the scope and authority of the planned Independent Payment Advisory Board to prevent misguided payment cuts that undermine access to care and destabilize healthcare delivery, and we will address the implementation of new value index adjustments to physician payments. Healthcare reform didn't change the status quo on private contracting, and we need to expand the rights of patients to privately contract with the physician of their choice without penalties.

This bill is not the final step; it's simply the next step toward real health system reform. Ultimately, history will judge whether the decisions made during this historic and turbulent time were the right ones. In the meantime, the AMA will remain fully engaged in an effort to help secure the best outcomes for physicians and the patients under our care.

J. James Rohack, MD, is president of the American Medical Association. Send your feedback to
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