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Inaugural address
2001 Annual Meeting
Farewell address
2001 Annual Meeting
Finance presentation
2001 Annual Meeting
Remarks of the executive vice president
2001 Annual Meeting
"Taking on our share of the global health burden: Opportunities for the physicians of America"
2001 Annual Meeting
Panel remarks Joint Commission on Accreditation of Healthcare Organizations
2001 Board of Commissioners Retreat
AMA update: A prescription for hope and health
Medical Society of the State of New York
Putting the "care" back in Medicare -- and managed care
North Shore / Long Island Jewish Health System
"Media and violence: Where does the buck stop?"
21st Annual Medical Communications and Health Reporting Conference
The role of organized medicine and the future health of Hispanic families
National Hispanic Medical Association

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Health Care Reform and Legislative Issues at the National Level
Palm Beach County Medical Society

Palm Beach Gardens Marriott
West Palm Beach, Florida
May 10, 2000
6:00 p.m.

D. Ted Lewers, MD
American Medical Association

Thank you, Dr. (Clay) Baynham.

And thank you, ladies and gentlemen, for that warm welcome.

It is a pleasure and an honor for me to represent the AMA at your annual meeting.

I’ve been asked to discuss with you some of the aspects of the on-going reform of health care in America – and the legislative issues that surround it.

Now, that’s a very large order – and one that we could talk about – literally – for days.

So I will only cover some of the highlights.

And doing that – I should begin by saying all of the issues and actions are cooperative in nature – as all great accomplishments are.

It’s ironic that – on this very day back in 1869 – that famous golden spike was driven into the railroad tie at Promontory Point in Utah – completing the transcontinental rail network.

That, too, was a massive, complicated undertaking. But at the heart of the matter were literally thousands of individuals – working together to make it happen.

From that point of view, you and I have been driving some golden spikes of our own lately – welding our societies together in an effective instrument for positive change.

And, we’ve seen some definite signs of progress.


One of the more encouraging signs has been the broad, national, bi-partisan support for our continuing battle for meaningful protections of the rights of patients in this country.

Specifically, in the last 6 years, the AMA has worked to pass a Patients’ Bill of Rights that both protects patients – and holds insurance firms accountable.

The House of Representatives gave overwhelming support to our approach last year -- passing the Norwood-Dingell bill.

Unfortunately the Senate caved in to the insurance industry’s $100-million-dollar propaganda campaign and passed what I would call the insurance company protection bill.

Now a joint Senate-House conference committee is working to resolve the wide differences between these bills.

The AMA is running ads right now in states represented by key members of the conference committee – calling for real patient protection:

  • Like protecting all 168 million Americans covered by managed health care plans;

  • Like holding health plans accountable when they make decisions that harm patients;

  • Like providing independent, timely appeals process if patient care is delayed or denied.

Those ads started running last week in the seven states whose U.S. Senators are members of the conference committee – a committee that is making decisions now that will affect the health of our patients for years to come.

Meanwhile, the American Association of Health Plans began a scare campaign that blame medical errors on physicians and call them the real problem with health care today.

The AMA yelled “foul” and wrote an open letter to the AAHP saying, “Your recent ad campaign sets a new low.”

“The AAHP is only interested in patient safety as a tool to block enactment of meaningful patients’ rights legislation.”

We’re hopeful – today – that whatever emerges from the conference committee does what it should do – protect the patients of America not the insurance companies of America.


We’re keeping the full-court press on for more than patients’ bill of rights.

It is one of the themes of the new AMA National House Call – a grassroots, state-by-state, city-by-city effort to make sure each presidential candidate takes a strong, positive stand on health care issues.

Not just patients’ bill of rights.

But meaningful Medicare reform, adequate coverage for the 44 million Americans not insured today, proper use of the tobacco settlement funds –

And other issues that poll after poll show are the number one or two or three top issues in the minds – not of the politicians – but of the American people.

And the grassroots approach is paying off. A few weeks ago, The Wall Street Journal reported the words of a GOP strategist who said – and this is her quote – “You cannot be a majority party unless you talk about issues that the majority of people care about.”

And she was talking about health care issues.


One of the issues the presidential candidates and all Americans should be talking about is the Quality Health Care Coalition Act of 1999 – the Campbell bill.

It would allow self-employed physicians the right to negotiate collectively with health plans.

It would offset the enormous advantage insurance companies have in dictating what the underwriters think is appropriate patient care – and appropriate levels of quality.

The bill overwhelmingly passed the House Judiciary Committee in March – and soon will be voted on by the House of Representatives.

Now is a good time to contact your representative and remind them of how essential it is to level the playing field for physicians.

There isn’t much time left – the Summer Recess is approaching. So I would act now, if you already haven’t.


An issue that is no longer in doubt is the new vehicle for physician advocacy named Physicians for Responsible Negotiation – or PRN.

It is up and running independently of the AMA.

And right now, it is working on its first contracts to represent physicians who – until now – had little or no voice in dealing with their big, managed care firm employers.

PRN has its first bargaining assignment – representing physicians working for the Medicaid HMO in Detroit named Wellness Plan.

Those physicians had feared they would have no say in the plan’s future.

And we physicians are men and women who have very critical stakes in the futures of any plans – especially where patient care and quality of care issues are concerned. It’s our job. And PRN will help us do it.

And PRN will do it without strikes, without shutdowns or slowdowns, without any of the abuses its critics screamed at the time PRN was formed – criticism that tried to scare a public that is more fearful of HMO abuse than physician organization.

PRN is a simple, direct, American way to settle disputes – and fight back again unjust abuse of power.


We are fighting back – also – against a potential unjust abuse of power in the wake of the Institute of Medicine’s report on medical error.

For all of the media coverage and emotion generated by the report, the issue comes down to no disagreement –

No debate or argument – over whether medical error exists or whether we can’t learn from mistakes and move on.

The debate, the disagreement, the argument has to do with the extent to which mandatory report of errors will result – not in learning and improvement – but in blame and lawsuits.

Long before the IOM report, the AMA helped launch the National Patient Safety Foundation,

With the avowed purpose of adapting airline and aerospace industry practices to error detection and correction.

That approach creates a culture of cooperative learning and mutual improvement – as opposed to a culture of blame and trial lawyer enrichment.

And that’s what we’re urging on the Congress now.

The NPSF approach needs to be incorporated into whatever system evolves.

The AMA will be involved at each step as the Congress studies the problem and designs a reporting and measurement system aimed at improving – not punishing.

Aimed at reporting and disseminating lessons learned – not blaming.

Aimed at finding prevention strategies – promoting them and helping implement them.

All in the interest of our patients.


Let me depart from legislative and labor issues at the national level and talk for a minute about direct, local actions the AMA has been taking.

We have partnered with 49 state medical societies to form the AMA Litigation Center.

It currently is pursuing 22 cases – in state and federal courts – on behalf of physicians and their patients.

Some samples:

  • The AMA and the Medical Association of Georgia sued Aetna/US Healthcare for money damages under Georgia law – because of late payment of physician claims;

  • The AMA and the Medical Society of the State of New York sued United HealthCare Corporation and Met Life – accusing the two firms of knowingly using flawed, invalid data to reduce their payments for medical services;

  • The AMA prompted an investigation of anti-competitive practices within two Pennsylvania Blue Cross and Blue Shield associations.

And the list goes on – but the message is the same:

The Litigation Center advocates in the one way our adversaries understand – in the courtroom.

There’s a second private sector initiative you’ll be interested in.

It’s the AMA Model Managed Care Contract – now updated and to be unveiled next month at the AMA Annual Meeting in Chicago.

The revised model contract speaks to such emerging contract issues as “all products” policies, reimbursement issues and plan bankruptcies – as well as strategies you can use to challenge health plans.

All designed to help you in your practice.


And speaking of help – that’s just what the AMA did in forcing HHS to update payment systems in last fall’s Balanced budget Refinement Act.

We went after HCFA to increase Medicare physician payments – to catch up with reality – and HCFA announced a 5.8 percent target growth rate for this year’s Medicare physician payments – a record level for them.

The original Sustainable Growth Rate would have been 2.1 percent. Now it’s 5.8 – more than double and more rational, in the bargain.

And more in your pocket in the days ahead.

The next step AMA is taking is pressure to force HCFA to update the methodology that produced the imbalance in the first place.

Last December we sued them – and we’ll keep advocating – to replace fuzzy thinking with real-world data and inclusion of new technologies in the backward-looking SGR process.


One very vital tool – and a last area I’ll touch today – is the Internet and its potential for impacting health care reform.

You’ve probably seen all the hype and heard all the predictions of the info-enthusiasts out there.

But the AMA is taking the initiative in directing Internet technology in very practical ways.

Not only does the AMA have a very busy web site – whose popularity is growing every month – but we’ve adapted Internet technologies to solving very specific challenges.

For example, you may already be a customer of the AMA Grassroots Action Center.

If not, try it. All you need to do is log on through the AMA home page, and you can communicate directly with your senators and representative.

You can also access our new CITS system – the Compliance Interactive Tutorial System.

CITS offers you a wealth of practice information on current fraud and abuse regulations – how to respond when the Medicare carrier storm troopers claim billing errors or seek repayment for alleged over-payment.


What are the health care reform and legislative issues at the national level?

At heart, they are all issues of concern for our patients.

And they are issues of constant, continuing advocacy.

In each of these issues – in those we’ve discussed and others that come along – I cannot predict when or what will happen.

I can assure you, however, that –

  • The AMA will continue to work for a meaningful patients’ bill of rights;

  • The AMA will continue to work for equitable negotiations with health care employers and managed care organizations;

  • The AMA will work with your association and others to fight injustices and imbalances wherever they are;

  • And the AMA will use the Internet and any other tool at its disposal to make certain the physician’s voice is heard in Washington and the 50 states.

And we will do that –

Not only because it is the right thing to do – for it certainly is the right thing.

And not because it is the appropriate way under our form of government – for it certainly is the appropriate way.


We will do it because our patients need it.

We will do it because our patients have no voice like ours.

We will do it because our patients have – for 153 years – learned that the AMA –

And the county associations and the state medical groups and the specialty societies –

All are caring, committed, resourceful and persistent advocates.

For those Americans – for your patients – I congratulate you for what you have done.

And I thank you for what you will do – working with your colleagues all over America – in the days to come.


Last updated: May 22, 2000

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