Legislative Affairs Feature - October 2009
Tex Med . 2009;105(10):27-29.
By Ken Ortolon
The scene played out in cities across Texas this summer. Hundreds of people packed auditoriums and meeting rooms to express their concerns on health care system reform and hear what others had to say about it.
Starting July 29, the Texas Medical Association and various county medical societies hosted a series of "House Calls" throughout the state to allow both physicians and patients to express what they like about the current health care system and what they want from health system reform.
TMA President William H. Fleming III, MD, says the meetings stood "in sharp contrast" to the sometimes raucous town hall meetings members of Congress held throughout August that often featured angry outbursts by concerned citizens.
"People were congenial and courteous," Dr. Fleming said of meetings in Houston that he attended. "We got a lot of information from patients and doctors, as well."
TMA leaders say opinions on health system reform legislation pending in the U.S. House of Representatives were split among both physicians and members of the public. Despite the various viewpoints, though, people who attended the meetings seemed to share a passionate concern about the future of their health care.
"At this point, I would say the predominant themes that have come out of the meetings are people are concerned about high cost, they love their doctor, they want choice, and they want to keep the government out of their business," said former TMA President Bohn D. Allen, MD, of Arlington, who represented TMA at several of the House Calls through the state.
Me and my doctor
TMA and the county medical societies sponsored the meetings as part of TMA's "Me and My Doctor, We Know Best" patient-physician action campaign designed to keep patients informed on health reform issues and give them an avenue for grassroots advocacy.
"The most important people in the national health care debate are sitting in your exam room right now," Dr. Fleming said in announcing the campaign. "Working together, physicians and patients need to make sure Congress and the president fix what's wrong with our health care system and keep what's good."
In addition to the meetings, the Me and My Doctor campaign includes patient education materials for use in physicians' waiting and exam rooms. An online advocacy center for patients at www.MeandMyDoctor.com gives concerned patients an easy way to contact their senators and representatives, as well as share their thoughts and concerns with TMA.
The meetings were held in July, August, and September in Denton, Austin, Houston, Plano, McKinney, Dallas, Tyler, Beaumont, San Antonio, Corpus Christi, Lubbock, Fort Worth, and Wichita Falls. At press time, several others were in the planning stage.
The House Calls drew up to 200 to 300 people in some locations, and about 700 gathered at the Montaigne Center at Lamar University in Beaumont. Dr. Allen estimates a quarter to a third of attendees were physicians, but the crowds also included other health care professionals, small business owners, retirees, lawmakers and/or their staff members, and even representatives of the liberal advocacy group Moveon.org.
TMA President-Elect Susan Rudd Bailey, MD, was struck by how different the tone at the TMA-sponsored meetings was, compared with the congressional meetings that drew angry protests. Attendees were civil and respectful to TMA and county medical society leaders who hosted the meetings, as well as to each other, she says.
In Austin, virtually all speakers were applauded for their comments, regardless of which side of the issue they were on.
TMA leaders say views of health system reform have differed greatly among Texans who attended the meetings. Dr. Bailey says the Denton meeting drew a large number of Medicare recipients who were concerned about end-of-life care and potential reductions in Medicare benefits.
"The patients are genuinely concerned about our health care system," she said. "They like their doctors, they want to keep their doctors, and they seem to be extremely concerned about losing what they have now."
Dr. Allen says participants in Tyler, Plano, and McKinney strongly opposed the so-called "public option" in House Resolution 3200, which would create a government-run health plan to compete with private health insurers. In Austin and San Antonio, opinions over the public option were more evenly split. In fact, a number of physicians and nonphysicians at both meetings not only supported the public option, but also favored a single-payer system.
In Austin and again in Corpus Christi, Geoff Tudor, a former health care attorney with a heart condition who is currently unemployed, spoke in favor of the public option. "I happen to be one of those unfortunate people who's in the position now of being unemployed and having no health care insurance," Mr. Tudor said at the Austin event. "I'm also a heart patient facing an operation next year that if I can't pay for it, I'll die. No one should have to go through this."
Mr. Tudor called for an "individual, portable public option under a government plan."
But Brenda Hutchison, a stage 4 breast cancer survivor, said she is not sure a public option plan would have allowed her the "innovative treatment" that has kept her alive the past four years.
"As my stage 4 cancer might progress a little, we can shift immediately to things that are changing," she said. "That's kept me alive a lot longer than any cost-benefit analysis could ever account for under a benefits system where someone has to determine benefits for you."
Shaping the message
Both TMA leaders and members of the public who attended the meetings say they were very useful. Lisa Hunter Ryden, of Leander, who attended the Austin meeting, says that despite opposing viewpoints, "most of us were able to express our opinions, and our opinions were listened to."
Charlotte Smith, MD, president of the Travis County Medical Society, said the meetings' goal was to have "productive conversations so we can learn from one another and find the best health care solutions for our patients.
"We want true health care reform that puts our patients first," she said. "Hearing from patients was the first step in that."
Dr. Allen says comments from the meetings and those posted at the Me and My Doctor Web site would help shape TMA's advocacy message as debate on HR 3200 or other reform plans proceeds.
Dan Finch, director of TMA's Legislative Affairs Department, told participants at the meetings that TMA would evaluate any reform plan moving through Congress on the basis of whether the solutions proposed are efficient; whether they hold doctors, hospitals, other providers, insurers, and the government accountable; and whether they will work to fix the problems that have been identified.
There are some things TMA likes about HR 3200, such as insurance reforms that would prohibit arbitrary canceling of insurance policies and require more disclosure on premium pricing, Mr. Finch told the audience in Austin. But there also are concerns, including lack of medical liability reforms and failure to permanently address Medicare physician payments.
In the end, Dr. Bailey says the most valuable thing to come from the meetings was a strengthening of the bond between physicians and patients.
"These meetings are helping to remind everybody - physicians and patients alike - that we are the most natural, the most powerful team in this debate," Dr. Bailey said. "It all centers on the patient-physician relationship, in my opinion, and how to best protect that so patients get the care they need and doctors are able to stay in business. I hope these town hall meetings will help patients and physicians remember that we are each other's strongest ally."
Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by e-mail at Ken Ortolon .
October 2009 Texas Medicine Contents
Texas Medicine Main Page