While the Web site says the AMA’s work on cost containment is “ongoing,” it lays out some broad strategies, such as reducing preventable disease, making health care delivery more efficient, and promoting value-based decision making at all levels—whatever that means. There’s not much here that would keep a well-heeled radiologist from sleeping at night. The AMA’s “pillars of reform,” however, probably sound reasonable to ordinary patients whom the AMA is enlisting to bolster its underlying agenda—stopping any proposal that would threaten doctors’ incomes.
Through its Patient Action Network, the AMA is looking for willing patients to receive “important updates on issues” that will affect their access to quality health care. The AMA says it will notify them when they can make a critical difference in legislative outcomes. Sounds to me like they’re ginning up a letter-writing machine and building a stable of “fly-ins”—people who can come to Washington and make their concerns known, an tactic used effectively by the insurance industry.
How is a poor soul in Congress to know which of these “grassroots ambassadors” have been coached by advocacy groups, and which are honest-to-goodness representatives of the public? How are reporters to know before they interview them for their stories? A member of Congress may throw up his or her hands and listen to the group that gave the most money. Reporters can’t do that. Their work requires some hard digging before they pass along quotes from fake agents of the grassroots.
Please understand that the AMA, physicians, nurses and the ANA are four distinct and often competitive, constituencies. Physicians continue to be very worried about perceived territory and practice control threats by nurses. Nurses only enjoy about a 10% rate of collective representation - and the only groups of nurses who are represented are those deemed as non-managerial. To confuse further, the nurse administrator group has organized under the American Organization of Nurse Executives as a subsidiary of the for-profit American Hospital Association, and these nurses exhibit corporate loyalty and fealty to employers much more than to nurses and patients. The American Nurses Association continues to lose nurse members and has been eviscerated in its feeble efforts at joining in healthcare reform. It only has produced a single, out of date white paper addressing just a few key parts of reform, while mostly focusing on tangential secondary issues.
However, reporters would do well to look for professional nursing failure or absence at the root of every clinical problem and preventable error which results in harm or death. It's the key piece of stories which to date have not been reported. But to gloss over the specific role of professional nursing in protecting patients' safety and assuring that their healthcare is coordinated and provided correctly in a timely manner and in the right setting is to miss the crux of the story.
Finally - hospitals account for only one setting and part of the healthcare infrastructure. The majority of healthcare services are delivered in ambulatory settings - offices, clinics, labs, etc. Another significant percentage of services is delivered in long term care settings: nursing homes, inpatient rehabilitation settings. It is not sufficient or accurate to portray hospitals as the sole care setting stakeholder. It is also incomplete reportage to list costs from care as solely arising from hospitals. The balance of services, spending, costs and patient outcomes should always include preventive/primary/public/ambulatory versus tertiary/high tech/high complexity/high cost/inpatient
#1 Posted by Annie, CJR on Wed 7 Jan 2009 at 03:13 PM
Annie's point is well taken, and I would add some more about physicians.
Surveys of physicians show the majority of us are ready for serious healthcare reform, including a sizeable number for a single-payer system. Aside from Physicians for a National Health Plan, most of us do not have a voice. AMA, by policy at present, opposes single payer for ideological reasons and PNHP, at this point advocates only single payer. That leaves many of us without a political voice, as most of our specialty societies do not weigh in on such matters. A few do, but most do not.
Those of us who favor a universal system such as those of Germany or Switzerland, but who may not be prepared to endorse single payer, are without a real voice. Some of us are trying to organize, and with some luck, we will be able to put together some leadership that will be allowed at the table to offer an approach that might reflect the majority of physicians and patients.
#2 Posted by cmhmd, CJR on Thu 8 Jan 2009 at 06:34 PM