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OB/GYN Editorial April 2004
Be Ready
Thomas E. Nolan, MD, MBA
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Arecurring theme in many of my editorials is the need for physicians
to become politically active to protect the integrity of our profession
(which is noble, despite the attacks from multiple fronts) and
the well-being of our patients. To this end, I applaud the American
College of Obstetricians and Gynecologists for initiating the Physicians
for Women's Health Organization, which is a nonprofit lobbying
organization created by the College. Any major organization or
political entity requires an active lobbying group to be effective
in the political process. Even though some individuals may feel
that this represents a "lowering of standards," the trial
lawyers will continually block any efforts that we have for meaningful
tort reform. As more problem areas in the United States evolve
(crisis states or "red states"), physicians in several
states have effected change when they joined together with a common
voice. As we are going to press, Senate Bill S. 2061 has been introduced
as of February 10, 2004 (for full text, link is http://frwebgate.access.gpo.gov/cgibin/getdoc.cgi?dbname=108_cong_bills&docid=f:s2061pcs.txt.pdf).
The preamble to the bill states:
To improve women's access to health care services and provide
improved medical care by reducing the excessive burden the liability
system places on the delivery of obstetrical and gynecological
services.
The bill was introduced by Senators Judd Greg (Republican of New
Hampshire) and John Ensign (Republican of Nevada). Several important
aspects of this bill include a statute of limitations on how long
an obstetrician will be at risk for a delivery and a capping of
noneconomic damages. This is a boilerplate of what national tort
reform is beginning to address in limiting liability burden on
OB/GYNs. These senators need to be commended for addressing a problem
that has been unique to our specialty. Unfortunately, states regulate
torts and the legality of federal legislation may be problematic.
(Late note: the bill was called for a vote and defeated by a 48-45
vote. This action was considered a political action so that nonsupporters
will be identified in the November 2004 election.)
In the February 23, 2004 edition of Fortune magazine,
an editorial by Geoffrey Colvin (Colvin G. What do voters want?
a clean bill of health. Fortune. 2004;149(4):70) presents
a very interesting viewpoint on the public's perception of health
care. He quotes data from the Yankelovich polling group that "health
care" has risen from being a top concern for only 5% of Americans
in 2001, doubling to 11% in 2002, and rising again to 19% in 2003.
The American public, in my opinion, is beginning to feel the squeeze
that we have been publicizing for the last several years. This
includes a decreasing number of physician providers in relationship
to a growing American population; the insurance companies' unwillingness
to pay providers and making billing statements difficult to interpret
even by college graduates (from "this is not a bill" to
the collection agency in record time); and the general feeling
that the area of health care cost has continued to grow with no
perceivable return to patients. Health care recently increased
to 15% of gross domestic product, its highest level to date. The
recent passage of the Medicare drug bill is causing anxiety, especially
among younger and more affluent individuals who will ultimately
pay for these services.
Also on the political agenda is the "morning after pill" or
Plan B. Recently, a panel overwhelmingly suggested that Plan B
be made available over the counter. Many individuals (including
myself) think that this is the first attempt to have oral contraceptives
available over the counter. Even though this particular concept
is a firestorm in itself, it is interesting that the US Food and
Drug Administration has issued a 90-day "cooling off" period.
Many political operatives are now moving into place to once again
try to limit women's contraceptive availability. My feelings are
that this is just the beginning of a new battle on accessibility
and enhanced contraceptive freedom for women—one I think
ultimately will be won over the next 3 to 5 years. The libertarian
aspects of the American public continue to grow with a continuing
liberalization of social mores.
So, in closing, health care and the medical profession will become
important driving forces shaping the public debate policy in the
next decade. As more pressures are put on the system—with
a growing lack of providers, yet with increasing interventions
by misdirected governing bodies (who wrongly think that you can
legislate quality)—and a demand by the American public for
better access and better health care, we need to be ready to move
in step. Once public opinion recognizes a problem, action will
be demanded. We, as physician providers, need to be politicized
and ready to rise in unison when necessary. As I have worked closely
in organized medicine over the past 5 years, I have been impressed
that when proper pressures are applied, the outcome can be changed
by properly prepared and informed providers. The yell of the indignant,
while getting a fleeting moment of recognition, will not win over
the long run.
Like many of my colleagues from the '60s, it has not been an easy
journey for me to join organized medicine. However, the alternative
of being dictated by the uninformed and the irrational, as well
as the emotional aspects of political campaigns, is unacceptable
to me. Continue to support the College and our lobbying organization
as well as local politics. As Tip O'Neill once said, "all
politics are ultimately local," so please be the local voice
in your community.
Thomas E. Nolan, MD, MBA
Editor-In-Chief
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