Friday, April 6, 2012

Physician Leadership: An Alternative to Obamacare
You can always count on Americans to do the right thing- after they have tried everything else.

Winston Churchill (1874-1965), Remarks,  1954

April 6, 2012 – Donald J. Palmisano, MD, JD,  former President of AMA (2003-2004), Founder of Intrepid Resources®,   author of On Leadership: Essential Principles for Business,  Political, and Personal Success and an acknowledged present day  physician leader,  asked me recently to define leadership.

I responded with this definition:

Leadership is leading from the front, saying what needs to be done,  doing what needs to be done, inspiring your followers, and persuading your critics.

I have always believed physicians in the clinical trenches must take a leadership role if America is to have a workable, practical, equitable, accessible, and  affordable health system. We do not have such a system now.  The system ought to be bottom-up with  economic freedom,  patient choice between government and private plans, and universal catastrophic  coverage.  It is not enough to curse  the darkness. We must take the lead in offering  a reasonable alternative to the current chaos. We have yet to exhaust the possibilities of such a system.

Examining and putting forth the alternatives Is underway. Here is a comprehensive proposal by the Florida Medical Association suggesting the alternatives.

The Florida Medical Association Policies on Health System Reform

The Florida Medical Association (FMA) represents more than 20,000 physicians in the legislative and regulatory arena, as well as on public health and ethical and legal issues. As the largest professional association for physicians in the state, the FMA seeks to enhance the quality and availability of health care in the Sunshine State and to help physicians practice medicine. The following policies on health system reform were adopted by the FMA’s Board of Governors.

1. The FMA will advise congress on health system reform policies that it opposes and those that it supports.

2. The FMA supports the following policies to increase access to affordable and high quality care:

a.     Promote Patient Rights

i. Ensure that patients can receive medical care in their best interest within the patient physician relationship. ii. Ensure that third parties refrain from creating direct and indirect rationing of medical services. iii. Ensure that third parties refrain from creating “cookbook” medicine protocols that don’t help individual patients.

b.     Increase Affordability of Medical Services and Health Insurance

i. Limit or end guaranteed issue and community rating for health insurance products.

ii. Allow the interstate purchase of health insurance.

iii. Promote the growth and expansion of health savings accounts and ensure that covered medical expenses are broad for these accounts.

iv. Minimize state and federal health care coverage mandates.

v. Encourage competition in the health industry by ending Certificate of Need laws, repealing Stark rules and self-referral laws, and allowing physician ownership of health care facilities.

c.     Promote tax fairness for health care financing

i. Allow tax deduction for individuals who purchase health insurance outside of their place of employment.

ii. Expand contribution amounts for tax-free health savings accounts and ensure roll-over of unused funds each year.

iii. Create refundable, advanceable tax credits (vouchers) at the same rate regardless of income level for all Americans who purchase health insurance.

d.     Encourage private control of health care spending

i. Reinstate right of Medicare and privately insured patients to privately contract with their physicians for medical care.

ii. Create a choice for younger workers to contribute payroll taxes to an individually owned Medicare account or to keep money in the Medicare system.

iii. Allow Medicare beneficiaries who opt out of Medicare the right to continue to collect other Social Security benefits.

e.     Ensure economic sustainability of Government financed health care

i. Encourage transition of Medicare to an individually owned account for younger workers and subsidize cost of older workers who choose to transition to an individually owned account.

ii. Establish means testing for Medicare recipients for benefits and premiums.

iii. Reserve public financing of health care for those of lower incomes.

f.      Guarantee access to medical care

i. Ensure economically sustainable medical practices and health care facilities.

ii. Pass tort reform by capping payments for non-economic damages and protect patient rights by creating special liability courts and tribunals for liability cases. iii. Pay physicians and hospitals fair market value for services delivered to patients covered by publicly financed programs.

iv. Minimize regulations that increase cost of care with no benefit to individual patients.

g.     Ensure high quality health care and protection of patient and physician rights.

i. Ensure fair and strenuous board certification and licensing laws.

ii. Promote fair, unbiased peer review as basis of quality and protect this review through federal law.

iii. Ensure that only physicians practice medicine.

iv. Allow access to courts and full judicial review for patients and physicians participating in publicly financed health programs and ensure full payment of attorney fees to prevailing party.

3. The FMA opposes the following as health system reform policy:

a. Creation of expanded public financing of health care through a “public option”.

b. Individual and employer mandates to purchase health insurance supported by tax penalties.

c. Value Based Purchasing and Pay for Performance programs that are not compliant with the AMA’s Principles and Guidelines on Pay for Performance.

d. Mandated use of Electronic Medical Records or Electronic Prescribing.

e. Reducing physician and hospital payments to fund incentive programs for value based purchasing.

f. Bundling of physician payments with hospital payments for medical practice reimbursement.

g. Financial penalties to physicians and hospitals for non-participation or non-compliance with government cost control and medical practice control programs.

h. Economically undermining physician practices or hospitals by providing incentive payments for competitors in certain programs such as pay for reporting and accountable care organizations.

i. Increasing payments for medical home physicians by cutting payments to specialists. j. Public reporting of physician and hospital practice data.

k. Forced compliance with cost control protocols established by the Federal Coordinating Council on Comparative Effectiveness.

l. Expanded scope of practice of non-physicians to practice medicine.

Tweet:   The Florida Medical Association has offered  a  comprehensive set of  “bottom-up” alternatives  to Obamacare.

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