Saturday, January 30, 2010

Moving Forward

Scott Brown has won his Senate race, and we can all breathe a sigh of relief. The Democrats are in disarray, even "hysterical" by one report. The nation has taken a step back from the brink of an abominable health care plan. But even assuming that the bill does fade away and die, we still have much work to do. The health care system does need reform, but there is little agreement on the issues or the fixes.

I would still expect some sort of limited legislation to make it through Congress; the egos involved may not let the matter drop as has happened so many times in the past. But, we now have the blessing of a second chance, a reprieve, and possibly a window of opportunity which will allow our voices to be heard.

Many of my readers are movers and shakers in the world of Radiology, and many have access to powerful people in Washington. Now is the time to decide what we as physicians, as radiologists, and as Americans would like to see changed in our system. I think we can all agree about bringing self-referral to the forefront of the discussion.

We must take a different approach than we have before. With all due respect to those involved, the message promulgated by AMIC has not resonated well in Congress. The implication that services will be curtailed if rates are lowered did not have any effect in the discussions about DRA-2005, and likely it won't today. Since AMIC is tied to the various non-radiological societies such as the American College of Cardiology it cannot easily discuss self-referral. The "political expediency" of sitting beside the cardiologists when testifying before Congress almost destroyed our very credibility on self-referral. My suggestion as a hick from the boonies is for the ACR to separate from AMIC as quickly as possible, and do what must be done to be certain Congress truly understands what self-referral is all about. We have to clarify the issue as being anything but a turf battle, or a grab for money. We need to reestablish the message and the moral high ground it entails. And while we're at it, we need to be absolutely certain that the leadership of the ACR is truly and accurately representing us. We can have no more questions arise such as those coming out of Toledo.

Beyond this, we must help decide where the US is to go from here, since we cannot maintain the status quo forever. Do we want to push for universal care? Probably, although in reality it exists and we, the physicians pay for it by covering "self-pay" patients. Do we want a single-payor system? I don't, but some do, and we have to have the discussion. Should insurance companies be required to cover pre-existing conditions? My son has a chronic disease, and will be uninsurable once he is too old for my policy to cover him. However, others have stated here that such coverage would bankrupt the system. We all want tort reform, but how do we get a legislature full of the likes of former Senator John Edwards, litigator extraordinare, to agree?

And so on.

Again, we have been granted a reprieve, a blessing, if you will, by the fortuitous turn of events in Massachusetts. Let's have the discussions and go to Washington with ideas. We have what might be a once-in-a-lifetime opportunity. Let's not let it go to waste.

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