Wednesday, October 14, 2009

"...it is our professional responsibility to educate and advocate for effective reform"

On Monday October 5th, Drs. Margaret Flowers and Paul Hochfeld led a delegation of 15 physicians and nurses to the White House gate. The occasion was a Rose Garden ceremony with over 100 physicians in white coats invited, a photo-op to showcase support among doctors for the President’s effort at health reform.


Dr. Margaret Flowers, Congressional Fellow of Physicians for a National Health Program, was later contacted by one of the doctors allowed in the gates. The following is her response:
Don’t let the good be the enemy of the perfect

Thank you for inviting me to this conversation. I understand your concern to get some type of reform now. I hear your desperation. I have felt it myself. There is so much suffering that it is tempting to say – we must get something even if we know it is not the solution.

At some point we have to look at the facts that incremental change and compromise when it comes to health reform in this nation have not gotten us anywhere. While SCHIP is great, it has merely held the level of uninsured children at bay, not decreased it. Medicaid expansions have similarly not been able to keep up with the rising uninsured or been able to provide a financially sustainable and high quality solution. Why is this?

It is because the greatest impediment to health reform in this country is that the for profit (and not for profit in some cases, such as BCBS) health industries control the political process. No amount of incremental reform will change that. Regulation of the industry is expensive and has been ineffective. The industry can do an end-run around regulation so fast that it would make your head spin. With the proposed legislation, we will be throwing more money into an already overpriced and dysfunctional situation. We will delay enactment of better reform while we wait to see if this reform works, all the time knowing that it won’t. In the meantime, thousands of people will die unnecessarily, thousands of people will suffer, families will continue to go bankrupt and lose their homes, physicians will continue to leave practice.

Single payer was not supposed to be on the table this year, yet despite having little in the way of funding and no paid organizers (like HCAN has), we were able to move it forward and break through some of the media blackout through perseverance and dedication.

We must ask ourselves, how long are we willing to play the incremental game (knowing that while a few more get access to healthcare, many more continue to be left out)? When will we decide that we’ve reached the tipping point, and like other social justice movements, dig in and do the necessary work to enact change?

I am tired of hearing that we can’t have single payer or that it is not on the table. It will never be on the table and we will never get it until we do the work to put it there. We, as physicians (and the other health professionals), hold a unique position in society. For the most part we are seen as advocates for our patients and acting in the best interest of our patients (although sadly this vision is truer for nurses than for doctors). We are seen as "experts." Thus, I believe that it is our professional responsibility to educate and advocate for effective reform. If we work together we can create real change. But it is harder than showing up for a photo shoot. It takes a lot of time and travel and writing and speaking and money and a willingness to put our bodies on the line.

Until more of us are willng to do this, we will have to continue to settle for crumbs. I am not willing to settle for crumbs. My part in this drama is to be a strong voice for single payer. And I won’t give in until we get there. The stories that I hear from patients and docs keep me going. Nobody should be left out. Everybody should have the same level of care. It is our responsibility to fight for this. Anything less is unacceptable.

My two cents, for what it’s worth.

Respectfully,
Margaret


Additional comments from Dr. Andrew Coates:
Single-payer advocates should take note. Dr. Hochfeld was allowed to attend the ceremony, uninvited and at the last minute, because single payer cannot be ignored. Our persistence has proven effective. The goal of the mainstream discussion, orderly consensus for incremental change, with nary a ripple of discord, as remained elusive. Yet experience proves again and again that single payer swims just below the surface.

All year long it has become more and more clear – to more and more people – that single payer national health insurance is in fact the very least we need when it comes to health care reform that will work to improve our lives. As Dr. Flowers explains, "Anything less is unacceptable."

This just-below-the-surface dynamic, combined with clear and persistent advocacy, that has taken single payer from "off the table" to "on the floor" this year. We now learn that the vote on HR 3200 – and with it, the Weiner amendment that would substitute single payer legislation for the text of the bill – may be imminent. Activists around the nation are pulling out all the stops.

So the single payer presence within the beltway continues, even now, to increase, not diminish. We also recognize that soon we will begin a new chapter in our efforts to educate and advocate for a single-payer national health program.

Source: PNHP's Blog

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