I received a thoughtful email the other day, and though I only have partial answers, I wanted to share it and give my response.
I follow health care issues in the newspaper and on radio. I am as far from understanding the complexities of medicine and patient care as Pluto is from Mars. But, I often ask myself the question, where are the docs? The issues concerning health care: rising costs and the uninsured, sharpen with each day. Can the medical community organize among themselves and take a leadership role in implementing solutions for these issues? Can physicians be more than influential advocates? Can the medical community take the initiative to develop a health care system that is responsive to all, regardless of financial circumstances? By applying their culture of excellence, they can be valued by all who seek relief, not only by those who can afford it.
This is a good (series of) questions, and one I’m not terrifically well equipped to answer, as my role in medicine is in the practice and not the administration of medicine. However, I’ll give my grunts’-eye view.
Can the medical community organize themselves and take a leadership role? Well, probably not, but for several reasons. Some of that has to do with the analogy that getting more than three docs to agree on a policy is like herding cats, but also with the realization that there isn’t any one, or even series of answers to the major questions of reimbursement or access that a majority of docs agree on. Single Payor has its proponents, and they make impassioned arguments. Those opposed to a single payor system (and I’m one of them) are not willing to take the chance that the unknown devil is better then the one we have, and there’s not much middle ground there.
Can physicians be more than influential advocates? Not unless there’s a considerable shift in the focus of an awful lot of physicians who decide to embark on a career in politics. The solution to health care and costs isn’t in the hospital, or the state medical society, or with the AMA, though all are active in their respective legislative domains.
Ultimately, the ‘answers’ are political ones, they aren’t easy, and they aren’t made exclusively or even largely by docs. They’re going to be made by politicians, and ultimately by the voters (our patients).