TMA President William Fleming III, MD: Installation Address

May 2, 2009

First of all, let me let you know that I am extremely disappointed that I am not there with you in person.

Thank you very much, Josie. It is an honor and special privilege to follow you and the trail you've blazed. You have done yeomen's work representing the physicians of Texas, Josie. I have big shoes to fill. Again, thank you for your service to Texas.

I want to begin by acknowledging and thanking some guests here today, some of whom couldn't come because of my illness.

I'd like to ask all the members of Harris County Medical Society and our fantastic staff to stand and be recognized. It's been an absolute pleasure to work with you throughout the years. Thank you so much for your support.

I think back on the long trail that brought me to this podium today. I recall at a Christmas party almost 30 years ago when Dr. Betty Stephenson walked up to me and said, "We have a job for you."

Well when Dr. Stephenson had a job for you, you didn't ask what … you didn't ask why … all you said was, "When do I start?"

In addition to Dr. Stephenson I have enjoyed the guidance of many mentors along the way, they include physicians like Sam Nixon and Max Butler and Cliff Burris and Alan Baum and Bill Bailey and the list goes on. Thank you very much for sharing your insight and friendship.

And among all my mentors, I know that Dr. Frank Bryant is looking down from Heaven and smiling. He was a true trailblazer for African-American physicians in Texas. Dr. Frank Bryant almost became the first African-American president of TMA in 1993, however he eventually lost that race … to Dr. Betty Stephenson.

Thank you all so very much for being here today. I can't tell you how much it means to have you here with me. We've all been through so very much together … it just makes sense that you are here to take this step with me.

I am terribly proud to lead the biggest and best state medical society in the country.

You know … here in Texas we have world-renowned, world-class physicians and hospitals and other facilities. But Houston and Texas, "we have a problem." There are far too many citizens of Texas who cannot access these world-class services.

My friends, Texas is the uninsured capital of the United States. More than 25 percent of Texans have no health insurance at all. If you add in those who are seriously UNDER-insured, that figure creeps up to about 30 percent.

This 30 percent gets either no care, or delayed care, or poor care. And my friends, that's wrong. That's terribly wrong. While the rest of us - physicians and providers, taxpayers, those who have health insurance - pay for it with our wallets, THEY pay for it with their bodies … with their health … sometimes with their lives.

I learned a little bit about access over the last few days having been hospitalized in Houston hooked up to IVs. Even though I know the system … the system is broken. I have insurance, and still had hassles getting into the hospital. The bureaucracy is overwhelming.

The uninsured are up to four times less likely to have a regular source of health care and are more likely to die from health-related problems. They are much less likely to receive needed medical care on time … even for symptoms that they know can have serious health consequences if not treated.

As their numbers grow, we see the growing impact on our emergency rooms and clinics that eventually care for them when they're sick or injured. We see it in our practices. And those Texans who DO have insurance see it, because our families pay thousands more in premiums for our own policies just to pick up the slack. We pay higher deductibles and copays. We wait in longer lines in the emergency room. We pay higher taxes.

I learned a little bit about access over the last few days having been hospitalized in Houston with acute renal failure. Even with that. The system is broken. Here I am someone who knows the system, has insurance, and still had hassles getting into the hospital. The bureaucracy is overwhelming.

OK, so we've got 8 million uninsured and underinsured Texans. What do WE do about it? What can WE, those of us in this room … in the Texas Medical Association … really DO about it?

Let's look at what we HAVE done. Six years ago, we faced a huge crisis. The lawsuit abuse epidemic threatened the viability of our practices. Too many of our sickest and most badly injured patients could not find physicians willing and able to care for them.

And what did WE do? What did the TMA do? We pulled together. We put our 40,000 members and the amazing TMA Alliance into action. WE convinced the legislature to pass a far-reaching liability reform bill we knew would work. WE convinced the voters to pass Proposition 12 to make sure those reforms would stand up to even the most activist judges.

Sure, we had lots of help. But WE did all the heavy lifting. And did we get for it? We CURED the lawsuit abuse epidemic. We sent our liability premiums DOWN instead of up. We now have more Texas physicians more than willing to see the toughest, most complicated cases.

And we've attracted record numbers of new doctors to Texas … including obstetricians and emergency room physicians and to rural parts of the state … and neurosurgeons to places where they weren't.

So how do we apply those same resources, how do we mobilize our TMA and our TMA Alliance to this crisis? How do WE eliminate this gap where 30 percent of our population is uninsured or underinsured?

More immediately, how do we fix Medicare? It has evolved from a low-paying safety net for the elderly to a standard that's constantly pushing down payments from commercial insurance companies. It was never meant to be a standard. As our past president, Dr. Bohn Allen, noted in Texas Medicine , we are locked into an economic system over which we have no control.

Some would have us wait for the federal government to act. Ladies and gentlemen, I suggest that would leave us waiting for far too long … while our fellow Texans continue to pay the consequences. And I suggest that if government DOES act, WE won't like the consequences.

Already, the Obama administration and the Democratic majority in Congress are pushing hard for what they call health system reform. So far, they've been long on rhetoric but short on details.

When Washington finally does put a proposal on the table, your Texas Medical Association will be ready for it. A special committee created by our House of Delegates spent nearly a year putting together 17 guiding principles that it believes should shape any reform effort.

And Dr. Williams has appointed a Task Force on Health System Reform to score any proposed legislation against those principles. We can feel confident knowing that Dr. Nancy Dickey is the chair of that Task Force. We can feel confident that she and her colleagues will give us the right read on any so-called reform plan and help us bring constructive alternatives to the table.

Some would have us wait for the State Legislature to act. Ladies and gentlemen, I suggest that would be an even longer wait. Despite our lowly status as the uninsured capital of the United States, Texas leaders have just not seen this as a priority.

Many other states have tried to tackle this problem. Some have tried … and failed. Others have tried, they've made a change, now we're waiting to see if it works. Massachusetts is probably the best example of that. Now I'm not saying that the Massachusetts health reform plan was right for Massachusetts. And I'm certainly not saying that it would be right for Texas.

But here's what was right about what our friends up north did. They brought together physicians and hospitals, patients, and business and insurance companies and government leaders. They brought together Republicans and Democrats. They pushed hard to forge a compromise. Then, together, that alliance pushed it through the statehouse.

Now THAT is something that the TMA is uniquely positioned to do. We have the resources and the reputation in Austin to pull together that sort of coalition and broker a Texas-style solution. We started several years ago with our Healthy Vision Health Care Summits, but we were just tinkering around the edges of reform and frankly, we let our momentum slip.

I would like to see us revive that process and put Texas back in the lead, devising some REAL health care reforms that address our unique and very critical challenges here. Devising some real reforms that help our patients get the quality care they need … when they need it … at a price we can all afford.

Josie Williams already has given us a head start. She showed us how we can commit to quality improvement. How we can deliver better, more cost-effective care to our patients. And how we can document all of that. That is a key to gaining the confidence and support of the business community and our government leaders.

We have begun the Patients' Right to Know campaign to help our patients know what they're getting when they buy health insurance. But as bad and confusing and complicated as THAT system is, at least those families HAVE insurance.

We need to take up that same kind of fight for the OTHER 30 percent.

So many of us, individually and in small groups, are already doing as much as we can for some of these patients. I applaud the Project Access programs in Dallas and Austin and Denton. I applaud the Saturday-morning free clinics run by the Indian Doctors Association of Houston. I applaud every single one of you who takes call in the emergency room or treats a patient in your office when you know you'll never see any payment for generously sharing your wonderful skills. You are indeed "Trusted Leaders."

Ladies and gentlemen, the time is right for the physicians of the Texas Medical Association to fight for our patients in a MUCH BIGGER WAY. The time is right for all of TMA to become "Trusted Leaders" throughout this state.

TMA's extensive public opinion research indicates Texas patients are looking for someone to take the lead on their behalf … and it's their doctors who they trust most to do just that. And isn't that exactly why we are all here … to help our patients? Ladies and gentlemen, I ask you. Please join me in this task.

Thank you very much.


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