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Viewpoint: An Embarrassment for the House of Medicine

Hossfeld, George MD

doi: 10.1097/01.EEM.0000387717.72491.00
Dr. Hossfeld

Dr. Hossfeld

I recently attended the annual symposium of the Illinois chapter of the American College of Emergency Physicians. A board member described the many issues being debated by ACEP. My 30-year membership in ACEP is testament to my faith in it as an organization we should all support. Nearly all of our progress in legislation, reimbursement, and the like has sprung from its countless skillful members. That's not to knock the American Academy of Emergency Medicine, of which I am also a member; it is just historical fact.

At the end of the presentation when questions were fielded, a friend and similar lifetime ACEP member asked if the board at ACEP “was not embarrassed by the health care reform bill that eventually emerged because it contained essentially no mention of tort reform.” This isn't just about ACEP, certainly, because many specialty organizations, state and local medical societies, and the American Medical Association all share the blame. It is truly an embarrassment for the house of medicine that an issue that virtually all U.S. physicians agree is a bona fide travesty of medicine was not included in any meaningful way.

Of course, I am biased. My personal experience in the medicolegal system turned a professional pursuit into a passionate mission. (“Speak the Unspeakable: ‘I Was Sued for Malpractice,’ I feel like Dan Aykroyd or John Belushi in “The Blues Brothers:” We're on a mission from God. There is absolutely no question that meaningful tort reform would have to have been included in any health care plan before I would have endorsed it.

Many medical societies would respond indignantly that they, too, agreed tort reform needed to be included and say they never gave a public endorsement for Obamacare. That is true, sure enough, and AAEM and my state medical society were two of them. Unquestionably, however, John Q. Public's perception is that doctors endorsed the plan because that is what the administration repeatedly said. Numerous public appearances by the President with white-coated, smiling “doctors” behind him helped establish that. The AMA's early endorsement was the largest part of that delusion. Rebecca Patchin, MD, the chair of the AMA Board of Trustees, projected AMA membership at 215,000 physicians this year, down 20 percent. ( With the number of U.S. physicians ranging from 750,000 to more than one million, depending on who you ask, that hardly makes the AMA the voice of medicine. Many have speculated about the reasons the AMA signed on early, including the argument that only by working with the administration would they have the input to include tort reform and a permanent fix to the Medicare payment system.

I don't believe the AMA was alone in taking what they thought was the safe path, the one that would allow them to partner with the administration in whatever bill emerged. Many other societies, including ACEP, felt they could best satisfy membership interest by doing so. They reasoned that a seat at the table of negotiations was their best move. The result was that physicians undervalued their own power and influence with Americans, and gave it away without return. Somehow the inclusion of another 32 million Americans in ridiculously underfunded Medicaid, projected Medicare cutbacks of 21 percent, and a historic loss in the authority to determine the best medical care (and charges for services) for our patients doesn't look like anything but a stunning loss to me.

The fact is that no medical organizations screamed that a health care reform bill without tort reform was an absolute deal breaker. The house of medicine failed to understand or act on the power it had to influence America. That likely allowed the very close voting on a package that will fundamentally change America. We'll never know what a headline like “Nation's Emergency Doctors Blast Health Care Reform Bill” would have done to the prospects of the bill's passage. What's the worst that could have happened? It isn't like the feds could force us to see all comers for any reason and at any time without consideration of ability to pay, could they?

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