A Challenge to Our Presidential Candidates:
2000 National Leadership Development Conference
Thomas R. Reardon, MD
The first great challenge that was issued - and answered - was just less than 6 months ago. It was the middle of July - and more was 'hot' in Washington than the weather.
The summer of 1999 was shaping up as a monumental battle.
Because last July, after years of waiting for this moment, when Congress would make patient protections a reality:
The Patients' Bill of Rights was front and center.
At the AMA, on behalf of this bill, we had mounted our most vigorous lobbying campaign of the past 3 decades. We had fought for 5 long years and more. And we were there on every front:
Then, as the Senate engaged in 4 days of historic debate - televised word for word and from coast to coast - it became disturbingly clear. The real battle lines were now being drawn - between the needs of our patients. And the greed of the insurance companies.
And the worst possible thing was about to happen. Because in the wake of a $100 million dollar lobbying effort by the insurance industry, the Senate was ready to shove our patients aside - and bow to the will of the profit-mongers.
At the AMA, there was no doubt. We had to act quickly and decisively. And we knew what we had to do. We gathered the physician members of the House of Representatives - some of whom you'll be hearing from this morning.
And along with them, Dr Charlie Norwood of Georgia, a Congressman and a dentist, who, with Congressm Dingell and Dr Greg Ganske, was the co-sponsor of the Patients' Bill of Rights in the House.
We took an extraordinary step, in the most literal sense of the word. We marched from the House side of the Capitol to the Senate side. And there, in the bright July sun just outside the Senate itself, we challenged the Senate leaders head-on for what they were doing.
We rendered a second opinion on what they proposed to do - and we did it on behalf of the patients of America. And we did it - live and before the nation in a historic news conference.
So historic that it led the evening news that night.
Now, in spite of our efforts, the forces of greed did win that day. But the AMA did not quit. Our message was simple: We just would not stand for a watered-down Patients' Bill of Rights.
I don't have to tell you, perseverance paid off.
Because just 3 months later, the House of Representatives brought the bill we supported Norwood-Dingell bill, to a vote. By an overwhelming majority, the House Republicans rejected the dictates of their party leadership. And approved the real patient protections we had been fighting for.
Speaking in The National Journal, one Harvard political analyst called it QUOTE: "the AMA's most influential victory in 20 or 30 years."
And he was not alone. On the morning after the House vote, Washington woke up to The Washington Post with the headline: "House votes to increase rights of HMO patients."
And there it was, front and center above the fold, a photo of Representative Dingell of Michigan, of Lee Stillwell from our Washington office, and me as your AMA President . . .
A remarkable photo that quickly became an icon, representing not only the AMA's work, but our victory in lobbying for our patients.
That day was a turning point for the patients of America. And for our AMA. Because as you know, the Patients' Bill of Rights is now in conference committee.
The committee is scheduled to meet again just days from now and the committee is being subjected to a well-financed campaign by our opponents, a campaign to frustrate the will of the House and - I believe - of the patients of America.
I remain an optimist. I have high hopes that protections we have lobbied for so long to achieve will soon to become law. However, I also remain a realist. I know the real protection of our patients will not happen without your help. Or without the help of everyone you can bring to our cause.
Well - medicine did persevere. We kept on when others might have quit. And in the process we gained something even greater than a victory in Congress. Suddenly, the worldview changed. And the nation saw us - not just as an institution. But as an activist organization.
And our AMA was hailed as being what every advocacy organization yearns to become. The AMA became a true leader on the national issues that affect all of us.
A force that could use our voice, your voice, to change the face of health care in ways we'd never dreamed of before. That new perspective - that refreshing new way of seeing the AMA produced something else - a new dream - a vision.
Using our power to shape the American health care system from an entirely new platform.
We put this nation on notice - that we intended to take control of our issues - to shape the health care debate - in the most public ways possible - by defining the issues.
And not only to respond, but to drive the debate.
To ask that essential question 'Is it good medicine?' - not just in the corridors of Congress, where the rights of our patients were in the balance.
But at the highest levels of our American political process:
Right in the heart of the presidential campaign itself - and in every primary and polling place in the land.
And ladies and gentlemen, that's just what we have done.
We launched our second challenge.
And we called this second challenge - the AMA's National House Call.
In December, we launched the National House Call in Washington, surrounded by the symbols of democracy in action.
And since then, we've been on the ground in many of the major primary states. Iowa. New Hampshire. South Carolina. Michigan. Georgia. California. Tennessee. Louisiana. And right here in Florida.
But as activists - advocating for those with the greatest stake in the national debate on health care:
These are the great stakes in the health care debate. But we've also made it clear in state after state - that the tough questions about the politics of American health care must be answered.
We've shared our questions - not only with the candidates. But with the voters themselves. Giving them the chance to ask these essential questions of our presidential hopefuls - in the candidates' debates.
In the caucuses
And we need to ask over and over again: Is it good medicine?
These are not idle questions. In fact, we've made it clear that the answers matter very much.
Because the American people are clamoring for change. And that fact has been backed up. In survey after survey and poll after poll. One recent Washington Post survey found that 3 of the top five issues of concern to Americans are health and health-care issues.
And that's why, in a letter sent to the candidates even before we officially launched this campaign. We told them in no uncertain terms that we firmly believe: "No candidate can be elected next November without a solid commitment to the issues that mean the most to patients, physicians - and the health of the country."
The AMA endorses no particular party or candidate in this process. But only our particular prescription for change: A true Patients' Bill of Rights that will hold health plans accountable. The need for health care coverage for all Americans. And the promise of a Medicare system that will still be there when our children and grandchildren need it.
Policies born of long years of experience by those who know health care better than anyone - the physicians of America. The people right here in this room today.
And the response we've received has been phenomenal. Everywhere we've gone, we've garnered local and national attention, as well as the attention of the candidates themselves. They recognize that big RV with the AMA logo on the side. And they respect our presence as true opinion leaders.
And let me tell you - not one candidate has dared to ignore us. We've been face to face with most of the campaigns. And, many of the candidates themselves. And what's most important - they have listened.
And so has the national media. We've been interviewed on radio. On television. For the newspapers. We've run major advertorials to call attention to our presence.
Telling the nation that "we're driving home the biggest issues any candidate will face this year."
And it's already been one of the most tremendous achievements in grassroots political activism in the history of organized medicine.
Many of you have participated in this work. Our county, state and Alliance partners have played a fundamental role in this success.
And as I said, thanks in large part to your efforts, that success has been tremendous.
But for me, among all the bandwagons and the banners and the flag-waving of the presidential campaign trail - one thing stands out above all the rest. Not the voting. Not the debates. Not the town hall meetings. But the opportunities we have had to meet with patients along the way.
And the stories I am hearing from them convince me all the more that we are in the right place. At the right time. With the right issues. Medicine's issues.
Issues like the ones faced by a family I met at a pediatric hospital in Des Moines, Iowa, where one of the parents told me that their daughter needs medications that cost $5,000 a month. And their insurance requires a copayment - of 20 percent. Now, I don't have to do the math for you to have you figure out that that's $12,000 that family has to pay every year just for medications alone.
I ask you - as we've asked the candidates themselves - when our system forces that kind of hardship on a family - Is it good medicine?
Then I went to visit patients in an Iowa internist's office. One of them had quit his job to start his own business. But now he could not afford to buy health insurance as an individual.
Another man was in his 70s. And he was suffering from heart disease. His doctor had prescribed multiple medications. And now, well past the age of retirement, his wife had gone back to work just to pay for those pills. When our system makes health insurance that expensive - or when it demands that kind of sacrifice of our seniors - I ask you again - Is it good medicine?
And then, there was the story that stopped me cold. A story I will never forget.
Because I met another man that day. He had just turned 62. And he said to me, "Doctor, I lost my job to a younger man when I was 59. And I lost my health coverage.
"Now I have a lung tumor. And I have to decide - whether to spend my resources on radiation and chemotherapy to buy an extra year of life or to forego treatment now - and leave something for my wife."
No one in the United States of America should ever have to make a decision like that.
That man had a choice. Between selling his house to pay for treatment. Or leaving his wife with a roof to cover her head once he was gone. In the end, after long talks with his doctor and his wife, he decided to end his treatment, so that his wife would have a roof over her head.
Is it good medicine?
I have talked with these patients myself. I know their stories are true. And it is for their sake that we are out there asking those questions. Asking, Mr Candidate, "If you are elected, will you sign a strong Patients' Bill of Rights that really protects our patients? Do you support the concept of health coverage for all Americans? Will you work for a real plan for Medicare reform - a stable system for the generations to come? Do you believe it is time to return medical decision-making to the hands of physicians and their patients? Will you help deliver us from the bottom-line focus of the health care bureaucrats?"
This is what the AMA's National House Call is all about. And that is why the nation is listening. And the candidates are, too.
As we gather here this morning, the primary season is nearly behind us. The frontrunners have all but secured their parties' nominations. And the national campaign is taking shape. In the course of this election season, we have achieved a great victory.
We have moved medicine's message to the forefront of the national debate. But that is not enough. Certainly not enough for that patient forced to buy security for his wife at the expense of his own life. And not enough for that little girl - whose parents may soon be forced to choose between their home and the well-being of a family member who lives in it.
And that is why the National House Call will continue to push our priorities as the campaign continues. Taking our message beyond the primaries to all of the key places where the opinions of this nation and its leaders are being forged and formed.
To the meetings of the U.S. Conference of Mayors in June
To the National Governors Association and to the National Conference of State Legislatures in July
And on through the national campaigns this fall.
Just as it has been since the House Call began. Where the candidates go, we will go.
And we will not let up - we will not give up - we will not rest until medicine's priorities are the true priorities of the presidential candidates themselves.
This is what we are committed to do. And this is the goal we will keep carrying forward - through the national elections in November. Because our patients demand it. And - they deserve no less.
Our goal is to carry our priorities into the highest realms of the political process, to ask for a pledge that the promise of good health is made real.
These are lofty goals. High ideals. It is heady stuff for this family physician from Oregon. And it is also heady stuff for a medical organization that began its days with a simple commitment to ethics and the health of the public.
But there is no more appropriate forum for our priorities today. For years, we have labored together to create a body of health policy that has the potential to transform the American health care system for the better. But it is no longer enough to record those policies and to say they are ours.
As Bill Moyers once said, "Ideas are great arrows, but there has to be a bow. And politics is the bow of idealism." That may be a bit flowery - since the realities of politics are people and votes. So I would put it this way:
The ideas, the great arrows, stem from our devotion to our patients. As the physicians of organized medicine, our goals are nothing less than making our ideals - the kept promises of the American dream, itself.
But high as our aspirations are, we have not forgotten how this all began, or the events that brought us to this moment: The challenge to Congress to pass the true Patients' Bill of Rights that our patients need and deserve.
And this is and will remain our challenge to all of the candidates.
If a real Patients' Bill of Rights, one that guarantees accountability for health plans, one that returns medical decision-making to the hands of physicians; if a real Patients' Bill of Rights does not become law this spring, we will carry this battle into the Fall 2000 elections.
We will not stop until it is signed into law. In a year when Congress has produced precious little in the way of results for the American people, we can offer our representatives one major win - protecting America's patients. And in a year when so much is at stake, I urge each of you to take home with you a personal commitment to put even more pressure than before on your senators and representatives - especially those who are conferees.
To put even more pressure than before on political leaders regardless of party since ours is a bipartisan issue, a bipartisan concern -- a concern for what is best for all Americans. This not a Republican issue. It is not a Democratic issue. It is a patient issue.
Because at the end of the day, when all of the questions are asked and answered - there is only one question that truly matters. Only one question that speaks to our souls as physicians.
And to the lives and the hearts of patients all across America.
It's that fundamental question you see on the side of the House Call campaign vehicle.
And the question that has become the rallying cry of medicine in this 2000 election.
The question that we know so well.
And that through our advocacy, the candidates themselves are being compelled to answer:
Is it good medicine?
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Posted on 3/27/2000