8 simple rules for health system reform: A new sounding board

by Lesley Politi on May 5, 2009

8 simple rules for health system reform: A new sounding board

AMA support for President Obama’s basic reform principles gives physicians the opportunity to help convert promise into policy.

Editorial. May 4, 2009.



Some observers consider the latest White House call for comprehensive health system reform to be ambitious, but physicians are not ones to shy away from a challenging endeavor.

In an April letter to President Obama, the American Medical Association demonstrated its intention to meet that challenge and seize the opportunity. The AMA offered its strong support for eight basic principles that will serve as the president’s sounding board when it comes to reform efforts.

To pass muster with the administration — and now the AMA as well — any health system overhaul considered by Congress must:

  • Protect families’ financial health.
  • Make health coverage affordable.
  • Aim for universality.
  • Provide portable coverage.
  • Guarantee choice.
  • Invest in prevention and wellness.
  • Improve patient safety and quality.
  • Maintain long-term fiscal sustainability.

This list of principles may seem simple enough. But physicians especially know how vital all of these points are when contemplating a major system shakeup.

Keeping those basics constantly in mind will be essential when policymakers inevitably start tackling the more complex problems in the health care system. And because physicians experience those problems — and their toll — on a daily basis, they should be among the first ones those policymakers turn to for counsel.

Doctors also understand how many of these tenets must go hand in hand if comprehensive health system reform is to work. Expanding high-quality, affordable coverage to all Americans, for instance, will give patients better access to preventive care that in turn will help drive down the costs of health care for everyone. The AMA’s own framework for reform expands on all of the president’s points and provides a clear pathway for policymakers to turn the promise of principled health reform into concrete policy changes.

Pursuing a solution under these eight principles may be ambitious, but it does not need to be radical. That’s why the AMA reiterated in its letter to the White House that the nation should build on the current employer-based coverage system while boosting the existing safety net for those who fall through the cracks.

Still, there are many aspects of the current system that physicians will not be content to preserve. The AMA’s letter makes clear that antitrust laws barring joint contracting with payers also hinder close collaboration by physician practices on quality improvement and information technology efforts. The medical profession is committed to providing more efficient, cost-effective care, but physicians often are forced to practice defensive medicine in response to undue liability pressures. Physicians know firsthand the need for a comprehensive, seamless system of care for the nation’s most vulnerable patients but instead find themselves stuck inside Medicare silos that cannot be broken down.

All of this can begin changing for the better starting this year. Few of the policy questions will be easy to answer, but with a strong, consistent, disciplined set of principles guiding the way, the promise of a better health system for all can be within reach.

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