TMA President C. Bruce Malone, MD: Installation Address

May 14, 2011 

In this time of disruptive change, we cannot just say "No." We have to help create a reorganized medical marketplace that creates value for the consumer and gives us a right to practice in the “public” system while having the option to private contract with patients who want more.

Thanks for allowing me to serve. This is a roomful of servant leaders. We all share a love of the profession and respect for our colleagues. I am counting on all of you to help us make a change for the better as health reform evolves.

And speaking of respect, let me thank Sue Bailey, mentor and friend; national class medical leader and communicator; and next month, vice-speaker of the AMA House of Delegates. She led with a promise to help us survive and thrive in the new health care landscape. We must continue even further down that path because we are just now understanding the rules and details of what that job will be.  

Where Are We Now?

We are working in a system that costs too much. Business is worried that medical costs are going to make U.S. goods non-competitive. We have employer-based health insurance versus personal taxes in other countries and per-capita spending for medical care that is at least two … and sometimes three times other developed countries. We have amazing technology and skills, but overall, U.S. health is not outstanding because of obesity, diabetes, heart disease, and violence … and the uninsured.

We cannot just pretend these facts away. In this time of disruptive change, we cannot just say “No, we want things to stay as they always were” because change is happening all around us. If we think we don’t like radical change, we are really not going to like being irrelevant.

Where Are We Going?

 The new Affordable Care Act has doctors and patients confused. Factions challenge the mandate for insurance. (We cannot have universal coverage without some sort of mandate; our AMA policy is that we have individual ownership that is portable.) No commercial market can survive without the mandate if the popular guaranteed issue is part of reform. We may litigate our way into a single-payer system as probably the only viable option. The U.S. government pays for 40 percent of all care now.

TMA has said all along that we want to keep what is good … get rid of what is bad … and add what is needed to the Affordable Care Act. And we have written it down.   

In this time of disruptive change, we cannot just say “No.” We have to help reorganize the medical marketplace so that it creates more value for those who pay for it. We have to help reorganize the medical marketplace so it gives us the right to practice in the ever-expanding public system with the option to contract privately with patients who want more.

The good news is we spend such a large amount of money on health care that if the doctors who know how to treat are allowed to organize, we can cover everyone for basic services … and we can cover advanced care for those who want it. U.S. Rep. Tom Price’s bill on private contracting is the start of a terribly important legislative battle for American medicine.

Another new trend is doctor employment. TMA wants to be relevant to all doctors in Texas no matter how they are paid. We know that doctors need to be protected from some corporate methods, but like any innovation in medicine, organization of new care systems is crucial. So we introduced novel legislation to protect employed physicians’ clinical autonomy.

To satisfy the value proposition: We have to reorganize the medical marketplace so it delivers the right care … at the right place … at the right time. … and at the best price. Good medical care will never be cheap. Prevention can be.

 Focus on the Future

Looking ahead, there will be more regulation through the Independent Payment Advisory Board. There will be major changes to Medicare and Medicaid: President Obama’s devastating cuts versus Congressman Ryan’s vouchers that shift costs to individuals. There will be limited panels on commercial insurance based on cost efficiency, an urgent matter.

We cannot just say “No” to these changes. We have to offer a better way to our patients … to the government … to the private insurers and the employers. We have to reorganize the medical marketplace. We need private contracting to give us the ability to work within the public system no matter how misdirected. We need more patient choice.

We are often not very focused in our legislative agenda. We have opinions about everything and get real results on very few. The best result we have achieved in my memory was the 2003 tort reforms … because we were focused. We have to keep our eye on the real prize in this reform. We cannot just say "no.” As physicians, we must defend our autonomy or risk being dumbed down. We must create new forms of practice while making care safer.

Finally, if we work with our patients in mind, they will support private contracting because they will have more choices, and we will have more autonomy and the ability to continue to innovate and advance technology in practice.

We are so fortunate to have our life’s work be meaningful and valuable, combining increased population productivity with the privilege of being part of our patients’ lives.So let’s roll up our sleeves and meet the challenges. Let’s stop saying “No” to the change all around us … some of it is very necessary. Let’s be leaders in reorganizing the medical marketplace.

When we meet these challenges just as our predecessors have done … with science and innovation … we will be helping to create a unique American system of care that works for us … and that works for our patients.

I hope you all will help.

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