It’s time for 2010! Let’s turn the corner here, and not look back too long. 2009 started with George Bush as President -- doesn’t that seem a long time back at this point? And, it’s been a slog all the way through the year for the new Administration on many fronts. That said, the stock market has regained much of what was lost last year; and let’s hope the worst of 2009 is behind us. Our resolution for 2010 needs to be to apply all means to turn around this 2010 Payment Rule, and then also to design and implement a new and better payment philosophy and methodology based on improving payment and quality and effectiveness.

Think how well cardiology would do in such a reinvented system if it were real: we’ve helped America experience a 30+% reduction in morbidity and mortality in cardiovascular disease in the past decade. A reformed payment system should provide that level of reward -- the overall savings and ROI societal benefits would dwarf any reward to cardiology for these documented improvements. I know a lot of you are skeptical that something this logical and positive could even be realized; but don’t give up -- there is a lot of creative space in the health system reform arena to maneuver in. That said, instead of diving into that creative space when opportunities present, I have been increasingly concerned that we are getting caught up ourselves in partisan rhetoric that will impede our progress to promote our best future and protect our membership and their patients. (Drucker: “The best way to predict the future is to create it.”).  Let’s leave a lot of the cynicism and understandable frustration we’ve all been sharing in 2009 as part of the certain-to-be-damned legacy of the ugly “aughts,” a decade which started with a raging Wall Street, NASDAQ, and housing market, and with unwarranted optimism. 

On Partisanship
A lot of this recent history gets filtered through partisan perspectives. How partisan is health care; and how partisan is the ACC itself? In the public’s mind doctors are mostly Republicans, but is that so? I personally think we’re divided in a partisan fashion as much as the public is. Of course, I guess I should disclose in fairness to you that I am a registered Democrat, although my mostly liberal wife accuses me of being too often on the right side of the great divide. In truth, I reject both party platforms, and the far left and far right extremes that define them. I consider myself a fiscal conservative, and a social liberal. There are more people out there for me to relate to in these regards with each passing year.  Basically, like most Americans, I consider myself to be mostly in the political ‘common sense’ middle -- and in fact most voters now consider themselves to be ‘independents.’ I think that is a good trend. But we need to take heed of it.

Why? Because health care is largely non-partisan, and ACC needs to focus on the merits of each issue, not on a party platform or deliberated slanted party rhetoric, either left or right. If we can do that, we’ll be staying close to our patients and the public in the mainstream -- where we need to be to survive. From a partisan perspective, health care reform is evil for Republicans and good for Dems -- depending on who is in the majority. When Richard Nixon was the champion of reform (he favored the employer mandate that only Hawaii implemented), reform was then “good” for Republicans and evil for Democrats. Partisan politics is gridlock -- and we don’t do well in that future, colleagues.

The challenge of making positive change requires a more discerning, “bi-partisan” course -- we must exert leadership to influence folks on both sides of the aisle. Congress has forgotten completely how to do that; but we shouldn’t fall into the same trap. The vast majority of Americans are concerned about access, and are terrified about the effects of rising costs on families and business -- people mainly want some prudent reform to protect their ongoing access to good and affordable health care.

People are underwhelmed about health reform right now because the left media suggests the current bills lack a public option or single payer; and the right media suggests that we are moving toward communism and a totalitarian state. The bills may be full of screwy provisions in their 2000 pages, but there are sorely needed provisions in there too.

Staying the Same is Irresponsible
As I’ve said in previous blogs (to the praise of some and the consternation of others), the status quo in health care is unsustainable and a certain fiscal nightmare. Doing nothing is not a responsible course real leaders in health care should recommend. Our last 3 ACC  Presidents Jim Dove, Doug Weaver and now Fred Bove have been bold -- and have tried to find a critical path through the reform quagmire that truly reflects the membership’s goals and desires, along with what will protect the patient-physician relationship.  To just say no; or to take a purely partisan stance is not responsible.

Finding a balance is what we need to do together. 2010 will demand a lot of us in the policy arena, and everybody needs to try to be involved---the best way for most folks to do that will be through your feedback on issues to the BOT via the BOG (the Board of Governors) and our state chapters.

But please don’t get your policy perspective exclusively from the NY Times or the Wall Street Journal, or from MSNBC or Fox News -- your colleagues and your patients will be better sources of what is needed. Some kind of bill is almost certain to be passed. We need to make sure it is less toxic than it might otherwise while we’re simultaneously suing the government on the Rule. But considering the Medicare Payment Rule we have faced for the past 6 months, 2010 has got to be better, doesn’t it? (Or, let’s be sure we make it so anyway?)

I’m an inveterate optimist I must admit; although I am somewhat envious of pessimists -- they they are never disappointed. I admit the year is not starting off swimmingly, but there have to be some blue skies ahead out there…

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