Health-Care Reform in America: Healing the System

By Todd, James S. | National Forum, Summer 1993 | Go to article overview

Health-Care Reform in America: Healing the System


Todd, James S., National Forum


Physicians, like politicians, are a diverse lot. Generalists, specialists, members of group practices, salaried physicians, independent fee-for-service practitioners, managed-care devotees: we each have our own hopes and dreams, our own wants and needs.

When you get right down to it, though, there is one central, commanding denominator we share, and that is our devotion to the best interest of our patients. They provide the justification for what we do as doctors, and they guide our vision for the future of medicine.

This country at its best offers the finest, most advanced health care in the world. Still, it is no secret that for many Americans the present system does not work. We hear over and over of the millions without access to care. They are not a statistic to us as physicians, nor an abstraction. When we thing of the many Americans who are shut out of the system, it is the faces of patients that we see before us. They are patients who come to us only, if at all, in the emergency departments and charity clinics of America. Many of them, in fact, come only when their situation is so desperate that there is little we can do. At the other end of the scale, we are pushing the bounds of medical achievement, as stellar achievements beget astronomical costs. This bewildering contrast is the status quo as we know it today, and together we say: "The status quo has to go."

Throughout the reform debate, there have been those who would tar the medical profession with the label of "special interest." As physicians, we do have a special interest, the most special in the world. Our special interest is the welfare of our patients. We are the first to see the effects of a system that fails to meet the medical needs of people. We are able to bind the wounds of those who come to us, but we are often helpless to bridge the gaps in the system itself. That is why we were the first to put forward a plan for real and meaningful change.

In 1990, the American Medical Association first stated its vision for reform. It is a plan called Health Access America, and it has become a road map that shows every man, woman, and child in America the way to affordable, good-quality health care.

Health Access America was the first comprehensive plan for change offered by any major national organization.

Ever since it was formulated, it has helped drive the national debate over reforming the health-care system. There has not been a single serious proposal laid on the table that cannot draw from the components of the AMA plan. What would it mean if Health Access America indeed became the law of the land?

First, every person would be guaranteed access to high-quality health care. Every person would be covered by a standard package of medical benefits, regardless of employment or a preexisting medical condition.

Employers would be required to provide coverage to every employee and his or her family, with safeguards to keep small business alive. Expanded governmental programs would protect the unemployed or uninsured.

Patients would be free to choose their own doctors. They would also be free to pick from a range of options to pay for health care, including both managed-care plans, like HMOs, and fee-for-service plans.

We would use insurance and liability reform and streamlined administration to help contain existing costs. We would control rising expenditures in a variety of ways, without denying needed care. We would see the health system learn to live within its means, and live up to its promise.

The advocates of Health Access America propose to guarantee that families no longer live in the fear that they are just one paycheck away from medical catastrophe. At the very heart of the plan is a firm belief that any health-care system that will work is one driven by market forces and patients' choices, not by government control. It is a plan that emphasizes individual responsibility and celebrates the freedom to choose that Americans cherish as part of their heritage. …

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