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Letters to the Editor  |   August 2008
Election Year's First Shot Over the Bow: Reforms Needed
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Letters to the Editor   |   August 2008
Election Year's First Shot Over the Bow: Reforms Needed
The Journal of the American Osteopathic Association, August 2008, Vol. 108, 461-464. doi:10.7556/jaoa.2008.108.8.461
The Journal of the American Osteopathic Association, August 2008, Vol. 108, 461-464. doi:10.7556/jaoa.2008.108.8.461
To the Editor:  
What do former presidents of the American College of Osteopathic Family Physicians (ACOFP), like me, do in our spare time? We think of ways of revising the healthcare system in the United States. I hope that the readers of this letter can use the ideas that I offer both personally and professionally. I know that the Osteopathic Political Action Committee (OPAC) uses verbiage similar to the ideas in this letter on a daily basis,1 and I thank OPAC for its ongoing efforts to support reform. 
It is fair to say that the United States has the best healthcare system in the world. We have the best-educated physicians, widespread availability of superb technology, and the finest hospitals. National polls continue to affirm that Americans are satisfied with their own physicians and the services they provide.2 Yet, there is growing discomfort with the costs, structure, and direction of this system.2 It is clear that the US healthcare system faces critical problems. 
More than 40 million Americans have no health insurance coverage.3 Individuals may not have health insurance for a number of reasons. For example, they may have preexisting medical conditions; their employers may not provide coverage; or they may be between jobs and currently unemployed. Lack of insurance may cause an individual to delay seeking needed care for a medical condition that is readily treatable. 
Millions of other Americans face the problem of having to stay in mundane jobs simply because their employers provide decent health insurance. Still other people face financial ruin because of devastating healthcare expenses that their insurance plans may not cover. People may be worried that their health insurance coverage is not adequate and that healthcare expenses will edge out other family necessities. Furthermore, even if an individual is now adequately insured, there is a possibility that such coverage will not always be there for that person. These problems must be solved! 
As a physician, I am pleased that the US Congress is making an effort this year to advance national healthcare reform legislation.4,5 The presidential candidates have also committed themselves to achieving healthcare reform.4 As a past president of the ACOFP, I call on our nation's elected leaders to find common ground so that all Americans can be assured of the following: 
  • healthcare coverage that is retained regardless of employment, economic status, and health condition
  • choice of physicians and health insurance plans
  • medical decision-making by patients and physicians, rather than by government administrators or insurance clerks
  • high-quality healthcare
All Americans should have healthcare coverage at all times for a standard set of benefits. Coverage should continue even if policyholders lose their jobs, change state of residence, or become ill. Coverage for all Americans can be achieved through a variety of approaches. Such approaches may include a requirement that employers pay a percentage of the insurance premium for their employees and their families, and a requirement that individuals obtain insurance coverage—or at least pay a portion of the premium through the use of health savings accounts. 
There is no single best mechanism available for achieving universal health insurance coverage. In all instances, however, the government has an obligation to pay for coverage when employers and individuals need assistance. Congress must work with all interested parties to decide the appropriate balance of responsibility (ie, employer, individual, and government) in paying for such universal coverage. 
We all should be able to select our own physicians. These individual choices are and will continue to be influenced by the professional skills of the physician, office location, characteristics of the hospital where the physician provides care, personal preferences of family members, recommendations of friends, and cost considerations. A patient should always be guaranteed the ability to make these decisions for him- or herself. No one knows better than the individual patient the special circumstances that make any physician, hospital, or healthcare plan the “best” choice. It is important that individuals have the power to make these decisions based on what they perceive to be the best option for themselves and their families. 
Healthcare plans vary widely in their provisions. Some plans may limit patient choice in physicians and hospitals. Other plans may cost patients more money out of pocket. Patients should have the right to select from all qualified healthcare plans that are available in their areas, including fee-for-service plans, health maintenance organizations, preferred provider organizations, exclusive provider organizations, and benefit payment schedule plans. Guaranteed access to all qualified healthcare plans will ensure that people are able to choose the mix that is best for them. 
Today's healthcare marketplace is increasingly characterized by for-profit corporations and large managed care organizations, many of which are taking aggressive actions to control the delivery of healthcare services and reduce their costs. Although efforts to cut costs are appropriate and desirable, excessive concern for costs can interfere with the availability and delivery of health services to patients, thus diminishing the quality of those services. 
After any reform of the healthcare system, patients need to be able to work with their physicians to make decisions regarding the medical treatments that are best for them. All too often today, insurance company clerks or government administrators interfere with or delay the medical treatment decisions of patients and physicians. For this situation to change, physicians must be able to act jointly in their relations with insurers. Current antitrust laws prohibit physicians from engaging in collective bargaining with private insurance companies or government insurance agencies.6 Legislation needs to be enacted to allow physicians to negotiate for themselves and their patients with insurance companies and the government. 
Patients and their physician representatives should have a say about issues that affect healthcare quality. Patients should also have all the information they need to be able to easily compare physicians, other healthcare providers, and healthcare plans regarding value, quality, and patient satisfaction. 
Instead of government and insurer control over healthcare decisions, a private/public partnership should be established to develop a national quality-assurance program for healthcare. The goal of such a program would be to strengthen existing efforts of the private sector to promote quality standards and the appropriate use of health services. 
It is important that elected officials hear from concerned constituents before voting on any legislation reforming the US healthcare system. I strongly encourage readers of JAOA—The Journal of the American Osteopathic Association to write their senators and representatives and urge action on health system reform. In corresponding with congressional representatives on this matter, be sure to emphasize that any meaningful reform would include healthcare coverage that is retained regardless of employment, economic, or health status; freedom of choice in physicians and health insurance plans should be retained; medical decision-making is reserved for patient-physician interactions, rather than by government administrators or insurance clerks; and high-quality healthcare. 
In conclusion, through the years, I have greatly appreciated the importance of ACOFP's political work on behalf of the osteopathic medical profession and the “mothership,” the American Osteopathic Association. I am especially proud of efforts by Marcelino Oliva, DO, chair of the ACOFP's Committee on Federal Legislation, and Ray Quintero, the ACOFP's director of government relations. I urge JAOA readers to show their support for these efforts by thanking these hard-working individuals and by contributing to OPAC. 
Key issues. American Osteopathic Information Association—Osteopathic Political Action Committee Web site. Available at: http://www.osteopathicpac.org/key_issues.html. Accessed July 31, 2008.
Langer G. Health care pains: growing health care concerns fuel cautious support for change; October 20, 2003. ABC News Web site. Available at: http://abcnews.go.com/sections/living/US/healthcare031020_poll.html. Accessed May 21, 2008.
Paddock C. 47 million Americans without health insurance, Census report; August 29, 2007. Medical News Today Web site. Available at: http://www.medicalnewstoday.com/articles/80897.php. Accessed July 31, 2008.
Salisbury D. The rocky road through Congress; May 12, 2008. Human Resource Executive Online Web site. Available at: http://www.hreonline.com/HRE/story.jsp?storyId=93450456. Accessed July 31, 2008.
Arvantes J. Health care reform: Senate bill may provide starting point to fix health care system; April 25, 2008. American Academy of Family Physicians Web site. Available at: http://www.aafp.org/online/en/home/publications/news/news-now/government-medicine/20080425wydenbill.html. Accessed July 31, 2008.
Guadagnino C. Antitrust primer for physicians; March 2001. Physician's News Digest Web site. Available at: http://www.physiciansnews.com/spotlight/301.html. Accessed July 31, 2008.