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The Declining State of the Nation's Health CareAnd the Urgency of Moving Forward on Essential Reforms
Joseph W. Stubbs, MD, FACP
The American College of Physicians
Thank you for joining us for this report from America's
internists on the State of the Nation's Health Care.
I have had the privilege of serving as president of the American
College of Physicians for the past year. I've also had the
privilege of serving adult patients for the past 27 years as a
full-time internist and geriatrician in a nine-person primary care
group practice in Albany, Georgia. Every day, I see where the
rubber of health policy meets the road of real patient lives. In my
practice, we also have more than 50 employees and I have seen the
ratio of physician to staff grow from 1:3 to 1:6 in the last 10
years. We have had to raise the deductible on our own health care
insurance from $500 to $2,000. I understand the struggles of small
businesses just to keep the lights on.
Health care in the United States is facing an unprecedented
challenge of affordability and sustainability.
Yet a highly-partisan and polarized debate over health care
reform legislation regrettably has taken the country's "eye off the
ball"-from the urgency of implementing reforms to making health
insurance coverage more affordable, available and secure; to
ensuring a sufficient supply of primary care physicians and other
specialties facing shortages; and to reforming payment and delivery
systems to achieve better value.
The year-long effort to enact comprehensive health care reform
remains stalled in Congress, with no clear route forward, yet the
urgency of reform is greater than ever.
The unfortunate truth is that by many measures, the
State of America's health care is in decline.
I see patients every day struggling to manage the costs of
health care. Just last week, a patient of mine came to the office
in desperation. The manufacturing plant for which she had worked
and received health care benefits had closed and she had been no
longer able to afford her heart and diabetes medicines. When, in
desperation, she came to the office, her blood sugars were off the
charts, she had extremely high blood pressure -- 205/110 -- and she
had black gangrenous toes. As a result she had to undergo an
amputation of her toe that could have been avoided.
The American College of Physicians, representing 129,000
internal medicine physicians and medical student members, releases
this report today in an effort to re-invigorate the effort to enact
and implement essential reforms to improve health care delivery in
the United States.
ACP views health reform not from a partisan or ideological
perspective, but from the standpoint of what the evidence tells us
will be the most effective course of action.
Our review of the evidence tells us that comprehensive health
care reform is essential:
If health care reform fails. . .
Health care reform is integral to reducing the federal
government's structural deficit. It is not possible to achieve
substantial and lasting reductions in the deficit and public debt
without reducing the Medicare and Medicaid spending.
The struggles of so many of my patients -- like the one I
mentioned -- who do not have jobs or whose jobs no longer provide
health care benefits cannot wait. Unnecessary amputations, other
unnecessary avoidable complications of diseases, and unnecessary
deaths are tragically occurring every day. This growing American
calamity needs to be fixed urgently.
We are encouraged that President Obama has invited leaders of
both political parties to meet on February 25 to share ideas on
moving forward on consensus reforms. We urge them to consider
common ground - and common sense - reforms, including enactment of
policies to increase the numbers of primary care physician,
accelerate pilot-testing of the Patient-Centered Medical Home,
promote adoption of health information technology, and reducing the
administrative costs of interacting with health plans. We believe
that such reforms would have strong bipartisan support in
At the same time, we continue to believe strongly that any final
bill must include the key provisions from the House and Senate
bills to create a pathway to make coverage available to all
Americans, increase Medicare and Medicaid payments for primary
care, increase funding for primary care training programs, and
accelerate the pilot-testing of innovative payment and delivery
system reforms. We continue to support creating sliding-scale tax
credits, expansion of Medicaid to cover the poor- and near-poor,
insurance market reforms, and providing individuals and small
businesses a wide choice of affordable health plans through a
health exchange. Instead of "starting over" or passing a series of
small bills that will likely would not be effective, we believe
that Congress should build-and improve upon-the bills already
passed by the House and Senate.
We also believe that the President and Congress should seek a
bipartisan agreement on reform of the medical liability tort
system. A bipartisan agreement on medical liability reform would
demonstrate that Washington is willing to put aside partisanship to
develop solutions to a vexing problem that drives up health care
costs without ensuring fair compensation to patients injured by
We also believe that it is time for Congress, on a bipartisan
basis, to enact a permanent replacement for the Medicare
Sustainable Growth Rate (SGR) that provides stable and predictable
payment updates that reflect the costs of providing services.
Ending the constant threat of Medicare payment cuts is essential to
preserving access to care for millions of America's seniors and
military families insured by Tri-Care. We cannot support another
temporary "patch" that kicks the can down the road and with it, the
cost to taxpayers of enacting a permanent solution.
How can a small business like mine decide whether to give raises
to my staff or let some of them go when we are faced each year with
steep cuts in reimbursement like this year's 21 percent cut? How
can we afford to continue seeing new Medicare patients given the
possibility of such cuts?
We also are urging President Obama to use his executive
authority to increase primary care workforce capacity and to reduce
the time that physicians and patients spend on administrative
interactions that take time away from patient care.
How would ACP's recommendations help my
patients? Enhancing reimbursement for primary care
services is essential for enticing more of our young medical
students to pursue careers in primary care. Expanding the primary
care workforce will benefit all patients and all physicians because
it will ensure that there is someone who treats the whole patient
and who coordinates the patient's total care. Further, primary care
physicians will have more time to spend with their patients,
especially those who have multiple chronic illnesses. They will
have both the time and the ability to help patients have more
control over their own lives and their own diseases. And the
policies in both the House and Senate bills to provide coverage to
more than 94% of legal U.S. resident would ensure that my patients
never again have to delay care and suffer needless complications
because they lose their job, and with it, their health
The alternative to moving forward on comprehensive health reform
is an unconscionable abdication of responsibility by our elected
leaders to ensure that high quality health care remains available
and affordable for American families today, tomorrow and for years
Now, I am pleased to introduce Bob Doherty, the senior vice
president of ACP's division of government affairs and public
policy. He will describe the current political environment and
provide more information on ACP's policy recommendations in this
time of "urgency of moving forward on essential reforms."