Report of the President House of Delegates 1999 AMA Interim Meeting San Diego Marriott Hotel San Diego, California Sunday, December 5, 1999 Thomas R. Reardon, MD President American Medical Association

Mr. Speaker. Ladies and gentlemen. Members of the AMA House of Delegates –

Good morning.

Halfway through the year – and here we are. Gathered for the 201^st meeting of this historic AMA House of Delegates. And what a year it has been! With more successes in these six months – than medicine has enjoyed in a very long time.

When I spoke to you in June, I told you I wanted us to keep medicine strong for our children and grandchildren who follow us. And today, we are well on the way to doing just that.

I don't have to tell you that we've won a tremendous victory in Washington this year – in the form of a piece of legislation that has been our focus for five long years and more.

Today, the Patients' Bill of Rights is one step closer to becoming a reality. Closer, in fact, than it has ever been before.

The passage of the Norwood-Dingell bill in the House was a great triumph for patients, and one of the greatest pieces of AMA advocacy ever to emerge from the corridors of Congress.

We won in spite of the fact that the insurance industry mounted a $100 million dollar advocacy campaign just to try and defeat us. One hundred million dollars that should have gone for patient care. And with that, proved how very afraid they are – of a simple little concept called "accountability." In other words, holding them responsible when they take medical decisions out of the hands of physicians – and our patients are harmed as a result.

And ladies and gentlemen, those insurance companies should be afraid – because polls show that 70 percent of Americans – our patients and their beneficiaries – support the right to sue their health plans. They support accountability.

Our patients are asking the same question we are about the current state of affairs: Is it good medicine? Because it's as simple as this: The American people are fed up. They want change. And they are trusting the AMA to lead the way.

When I was on my way to the World Medical Association meeting in September, a woman approached me on the airplane in Germany. She walked right up and said: "You've been working with the Patients' Bill of Rights, haven't you?"

I said yes, I had – as I wondered how she could know that halfway around the world from home. And then, she explained. She had just seen my picture on the front page of the paper, standing with Congressmen Norwood and Dingell on the day after the House bill passed.

And as she reached out to shake my hand, here's what she said: "On behalf of the American people, I want to thank you. And I want to thank the AMA."

A few days later, I was travelling to speak at a symposium sponsored by the Robert Wood Johnson Foundation at Northwestern University in Chicago. My seatmate on that plane saw what I was working on. And leaned over and said, "I really hope that Bill of Rights passes. I'm scared to get sick – and I'll tell you, so are most of my friends."

Ladies and gentlemen, when people in airports and on airplanes start to approach you out of the blue -- have no doubt about it -- the American people are getting the message. And they stand alongside us in this most important of all fights:

• The fight to return medical decision-making to the hands of physicians.
• The right to a strong, external, independent and binding appeals process.
• Protections that cover all Americans who are in managed care plans.
• And perhaps most important of all – the right for patients to hold those plans accountable when they make medical decisions that result in negligence – and our patients are injured because of it.

I am often asked why 68 House Republicans supported the Norwood-Dingell Bill of Rights. And this is what I say: because they knew it was the right thing to do -- and they are listening to the voters. And -- they want to return to Congress after the fall 2000 elections.

Because in the end, this is not a Republican issue. It is not a Democratic issue. It is a patient issue. And the AMA has made it clear: We will not stop until the Patients' Bill of Rights becomes the law of the land.

And if Congress does not do the right thing and pass a strong Patients' Bill of Rights in early 2000 – we will continue our fight into the Fall 2000 elections and beyond.

Right now, the House bill that we supported and the Senate bill we opposed are in conference. And as I'm sure you know, before the recess, the Speaker of the House appointed his conferees to the committee. Hand-selected, by and large, from those congressmen who did not support the Norwood-Dingell bill. It's plain old political shenanigans at work.

However, their fellow Representatives have made it clear – through an overwhelming bipartisan vote – that they agree that the Norwood-Dingell bill should become the law of the land.

But those aren't the only shenanigans we're seeing in the wake of our success. Because as you know, after the vote on patients' rights, another bill that is near and dear to us – the Campbell bill – was summarily pulled off the agenda by the Speaker of the House.

The Campbell bill would finally give self-employed physicians in this country the right to collectively negotiate with health plans.

A majority of the House Judiciary Committee has co-sponsored the Campbell Bill. What's more, 173 Representatives are now co-sponsors.

So when the media asked me whether the Speaker had acted in retribution by pulling this bill – because of our strong support for the Patients' Bill of Rights -- here is what I told them:

"You will have to ask the Speaker of the House what his motives may be. But I can tell you this: We will not be intimidated. We will not be threatened. We will not be blackmailed. We will do – what is right. For the physicians -- and the patients -- of this country."

Now, in an apparent about-face, the Speaker has recently promised that the Campbell bill will be back on the early part of the agenda when Congress reconvenes. And we're going to hold his feet to the fire – and hold him to that promise. And we need you to do the same.

That's why we need your help. You and your colleagues back home need to contact your Representatives in Congress to request that they vote for the Campbell bill when it comes to the floor in February. Tell them it's time to do the right thing.

And the same goes for Congressman Bliley, and his sudden threat to open the National Practitioner Data Bank to the public. As you know, we've opposed opening the Data Bank for a long time – and so, incidentally, has Congressman Bliley's party up to now -- because the information it contains just doesn't give the public a clear picture of the quality of care a physician provides.

In fact, the Institute of Medicine report on medical error that was released just this past week says it flat out: the right way to deal with medical error is through initiatives like the National Patient Safety Foundation. Programs that help find out how error occurs and find ways to make it better – not a laundry list of incidents offered without context or explanation.

So when the media asked me whether I thought this latest push to open the Data Bank might be some kind of short-sighted retaliation or punishment, as well -- this was my answer:

"If that is the motivation – to punish us – and if that's what a political party does to constituents who disagree with them – then we've come to a pretty sad state of affairs in this country -- and in the political process of America."

But while we wait for Congress to act, the marketplace is already responding to our strong public advocacy for the Patients' Bill of Rights.

Last month, UnitedHealth Group – the country's second-largest HMO – made a major announcement. In fact, they said they were going to do something truly extraordinary – they were going to place medical decision-making back where it belongs: back into the hands of those who are trained to provide it. Back into our hands – the hands of physicians. Right where we have always said that it should be!

Why did they do it? Because UnitedHealth discovered they were actually spending more to scrutinize and micromanage our medical decisions than they saved in the process. And in the end, this, too, was as simple as what we've been telling everyone to do in every area of the health care debate – just ask "Is it good medicine?" – and see where the question leads you.

But even if they followed our high principles for a purely practical reason – in a word, economics -- here is the real bottom line: the managed care industry is listening. And that is not only a major victory for medicine – it's a great victory for patients.

In fact, The Wall Street Journal said it was nothing short of "a watershed event in the history of managed care that may well spur similar action from other managed care plans." And they may be right. Because just this past week, Karen Ignani, the CEO of the American Association of Health Plans, issued a memo to 1,000 health plans about the public reaction to the UnitedHealth Group's decision.

She said it "has created an extraordinary opportunity for health plans to change the dynamics confronting managed care – if [they] have the foresight to take advantage of it." In fact, she even said she'd be seeking a meeting with our AMA to address patient and physician managed care concerns.

Now, we're not naïve – we don't think we've achieved a cure-all. This decision doesn't address mental health, for one thing – and that's a major issue. And we're also on the lookout to make sure that retrospective denials do not now become a kind of perverse substitute for pre-authorization review.

But even as a first step, the implications are very clear – our work in Washington is paying off. The Patients' Bill of Rights will make a difference in the practices of today's medical marketplace. In fact, it already has.

But while the Norwood-Dingell bill of rights would apply to every patient covered by a managed care plan in this country – we know there are still far too many patients who have no coverage at all.

Our past president, Dr. Dickey, made health care coverage for all Americans an AMA priority – and a national one. You may remember last June, when our AMA joined with a coalition of six of the largest specialty societies in organized medicine to push this issue onto the national agenda.

We felt then -- as we do now -- that it was vital for our medical profession to state their commitment to this important issue. And in June, I promised Nancy Dickey – and you -- we would continue this work. Today, I'm happy to report that we have.

But as you know, this issue is larger than medicine alone – or even the 44 million uninsured patients at the heart of it. That means it will also take the committed efforts of others outside our ranks – to get the job done.

That's why, at the end of October, along with a team of co-conveners, our AMA inaugurated an historic gathering we called the Health Sector Assembly with this one aim in mind: to focus the attention of key stakeholders across America on the urgent need to find a way to provide health care coverage for all Americans.

Leaders from more than 50 organizations – representing every phase and factor in American society – from the AMA, speaking for physicians, to the managed care and the pharmaceutical industries – to government, academia, patient groups and think tanks.

We didn't meet to find solutions – but first, to learn whether there was the will to find those solutions. And it seems – that there is. A commitment to make it happen, from some of the most influential groups in our nation.

I won't list all of the principles we agreed on – just enough to speak to how they resonate with the vital work we've done here, in this House for a decade and more:

• First, that we must look on health coverage for all as an investment -- in the infrastructure of our country – the people – the health and the future of our nation.

• Next, that there is no magic bullet – and it will take multi-faceted, stepwise solutions to assure coverage for all of America's patients.

• And that the public and private sectors will have to work together to make it happen.

• But above all, that we must preserve what is best about American health care as we extend coverage to all Americans – and that we must do it without jeopardizing the 85 percent of patients who do have coverage now.

It's a tall order. But the Health Sector Assembly advanced the conversation to the next level. It showed there is the will to get the job done – and that's the next step in making our AMA goal of health care coverage for all Americans a reality for our nation and our patients.

Because that is the American way – if we can find the will to do something, then we can and we will find solutions. And that leads me to the final item I want to talk to you about today:

A brand new activity that's set to debut just in time to impact the primary elections.

It represents what may be the most sweeping advocacy action in all of AMA history -- aimed at placing health care issues squarely on the American agenda -- and on the platform planks of every Presidential hopeful in the 2000 race.

Issues like the ones we've been talking about this morning:

The Patients' Bill of Rights. Health care coverage for all Americans. Along with other key concerns – like Medicare reform. And issues surrounding the health of the public.

It's a chance to ask "Is it good medicine?" in every primary and polling place in the land. And that's exactly what we intend to do.

We plan to announce this effort nationally within days of this very meeting– so stay tuned – because you're going to see and hear a lot about it between now and Election Day 2000.

Why are we doing this? Because for a long time, the powers-that-be in politics and the marketplace have been trying to drive the shape of American health care. And it's time for us as physicians to take back the driver's seat.

Ladies and gentlemen, this nation is on notice – we intend to take control of our issues and shape the health care debate in the most public way possible: by defining the health care choices for the presidential candidates. And making sure that no candidate will be elected to the White House next November – without a solid commitment to the issues that mean the most to patients and physicians – and to the health of our country.

There's just one catch to this fantastic plan – we can not do it without your help. We're going to need your help to make this vision a reality.

And just like our successes with patients' rights – and just like the Campbell Bill – this plan won't work unless you're a part of it.

You are what you champion. That's our message to the candidates. And it is my message to you. Today, as we stand on the threshold of the 21^st Century, it is time to champion our future and the future of our nation, not one physician or one patient or one issue at a time. But all of us working together, to advance the full range of goals that lie before us.

Our unity this year has proven exactly how much we can achieve when we stay together – and how very powerful we can be -- not only in our own eyes and the eyes of our patients, but in the eyes of decision-makers everywhere.

As we move forward with our AMA agenda – let me remind you:

When we speak with a united voice, we are listened to.
When we are divided, we are ignored.
When we are united, we are powerful.
When we are divided, we are weak.
When we are united, we can – and we do – win
When we are divided, we often lose.

Ladies and gentlemen, the physicians and the patients of this country need us to be strong, united and visionary advocates – So that we can provide our patients the necessary and appropriate care they need and deserve.

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