Joel B. Finkelstein

WASHINGTON — Wouldn't reform be nice? That seemed to be the message from politicians speaking at a national advocacy conference sponsored by the American Medical Association.

Democrats and Republicans told politically active physicians about their ideas for addressing problems with Medicare reimbursement, the medical liability system, and, more generally, a health care system that is failing both physicians and patients.

"If our health care system doesn't work for doctors, it doesn't work," said Sen. Hillary Clinton, (D-N.Y.).

"It's fair to say that the AMA and I did not see to eye to eye," said Sen. Clinton, referring to her failed health care reform proposal when she was First Lady. "But it is 12 years later, and we have many of the same problems."

Sen. Clinton may not have been speaking to the friendliest audience, but she drew resounding applause from the physicians when she proposed that Congress stop legislating Medicare reimbursement freezes and replace the sustainable growth rate formula with something better.

Physicians at the meeting heard similar rhetoric from other lawmakers.

"Most of us don't want to go through this annual ritual," said Rep. Nathan Deal (R-Ga.). However, he also said that fixes are expensive and doctors shouldn't expect them to happen this year.

Rep. Edward Markey (D-Mass.) proposed that Congress form a task force to review the sustainable growth rate over a 2-year period and increase physician reimbursement 5% a year in the interim.

Republicans continue to push for caps on noneconomic damages in medical malpractice lawsuits, an approach supported by states in which similar caps have been linked to slower increases in liability premiums. Democrats oppose caps because caps put limits on legitimate lawsuits.

"Caps don't get to the heart of the problem," said Sen. Clinton. Instead, Congress needs to bridge the gap between liability reform and error-reporting legislation.

She cited the University of Michigan's "Sorry Works!" initiative—a program that encourages doctors and their insurers to be honest when mistakes happen and provide compensation up front to patients and their attorneys—which has cut liability costs, freeing up new money to improve systems that can reduce errors.

Democrats and Republicans demonstrated a similar divide on the uninsured.

Rep. Markey said that the government should expand Medicare, Medicaid, and the Federal Employees Health Benefits program to include more of the uninsured.

Rep. Tom Price (R-Ga.) said the last thing government should do is take over the responsibility for providing health care from private entities.

WASHINGTON — Wouldn't reform be nice? That seemed to be the message from politicians speaking at a national advocacy conference sponsored by the American Medical Association.

Democrats and Republicans told politically active physicians about their ideas for addressing problems with Medicare reimbursement, the medical liability system, and, more generally, a health care system that is failing both physicians and patients.

"If our health care system doesn't work for doctors, it doesn't work," said Sen. Hillary Clinton, (D-N.Y.).

"It's fair to say that the AMA and I did not see to eye to eye," said Sen. Clinton, referring to her failed health care reform proposal when she was First Lady. "But it is 12 years later, and we have many of the same problems."

Sen. Clinton may not have been speaking to the friendliest audience, but she drew resounding applause from the physicians when she proposed that Congress stop legislating Medicare reimbursement freezes and replace the sustainable growth rate formula with something better.

Physicians at the meeting heard similar rhetoric from other lawmakers.

"Most of us don't want to go through this annual ritual," said Rep. Nathan Deal (R-Ga.). However, he also said that fixes are expensive and doctors shouldn't expect them to happen this year.

Rep. Edward Markey (D-Mass.) proposed that Congress form a task force to review the sustainable growth rate over a 2-year period and increase physician reimbursement 5% a year in the interim.

Republicans continue to push for caps on noneconomic damages in medical malpractice lawsuits, an approach supported by states in which similar caps have been linked to slower increases in liability premiums. Democrats oppose caps because caps put limits on legitimate lawsuits.

"Caps don't get to the heart of the problem," said Sen. Clinton. Instead, Congress needs to bridge the gap between liability reform and error-reporting legislation.

She cited the University of Michigan's "Sorry Works!" initiative—a program that encourages doctors and their insurers to be honest when mistakes happen and provide compensation up front to patients and their attorneys—which has cut liability costs, freeing up new money to improve systems that can reduce errors.

Democrats and Republicans demonstrated a similar divide on the uninsured.

Rep. Markey said that the government should expand Medicare, Medicaid, and the Federal Employees Health Benefits program to include more of the uninsured.

Rep. Tom Price (R-Ga.) said the last thing government should do is take over the responsibility for providing health care from private entities.

WASHINGTON — Wouldn't reform be nice? That seemed to be the message from politicians speaking at a national advocacy conference sponsored by the American Medical Association.

Democrats and Republicans told politically active physicians about their ideas for addressing problems with Medicare reimbursement, the medical liability system, and, more generally, a health care system that is failing both physicians and patients.

"If our health care system doesn't work for doctors, it doesn't work," said Sen. Hillary Clinton, (D-N.Y.).

"It's fair to say that the AMA and I did not see to eye to eye," said Sen. Clinton, referring to her failed health care reform proposal when she was First Lady. "But it is 12 years later, and we have many of the same problems."

Sen. Clinton may not have been speaking to the friendliest audience, but she drew resounding applause from the physicians when she proposed that Congress stop legislating Medicare reimbursement freezes and replace the sustainable growth rate formula with something better.

Physicians at the meeting heard similar rhetoric from other lawmakers.

"Most of us don't want to go through this annual ritual," said Rep. Nathan Deal (R-Ga.). However, he also said that fixes are expensive and doctors shouldn't expect them to happen this year.

Rep. Edward Markey (D-Mass.) proposed that Congress form a task force to review the sustainable growth rate over a 2-year period and increase physician reimbursement 5% a year in the interim.

Republicans continue to push for caps on noneconomic damages in medical malpractice lawsuits, an approach supported by states in which similar caps have been linked to slower increases in liability premiums. Democrats oppose caps because caps put limits on legitimate lawsuits.

"Caps don't get to the heart of the problem," said Sen. Clinton. Instead, Congress needs to bridge the gap between liability reform and error-reporting legislation.

She cited the University of Michigan's "Sorry Works!" initiative—a program that encourages doctors and their insurers to be honest when mistakes happen and provide compensation up front to patients and their attorneys—which has cut liability costs, freeing up new money to improve systems that can reduce errors.

Democrats and Republicans demonstrated a similar divide on the uninsured.

Rep. Markey said that the government should expand Medicare, Medicaid, and the Federal Employees Health Benefits program to include more of the uninsured.

Rep. Tom Price (R-Ga.) said the last thing government should do is take over the responsibility for providing health care from private entities.

WASHINGTON — Physicians are increasingly willing to cross party lines on the issue of the uninsured, but convincing lawmakers may be their biggest hurdle.

It's in physicians' best interest to be involved in the debate over health care reform, Rep. Tom Price, (R-Ga.), who is an orthopedic surgeon, said at a national advocacy conference sponsored by the American Medical Association.

“What do you think is holding the current health care system together?” Dr. Price asked the audience. “You. It's the altruism of the physicians of this nation. That's what is holding this system together. It's the only thing holding it together.”

The conference brought physicians together with members of Congress from both parties to talk about the uninsured and other issues. Lawmakers encouraged physicians to participate in finding solutions.

“I am glad to be able to hear what Democrats and Republicans have to say,” said Dr. Charles Anderson, an internist in group practice in Naples, Fla. “We're not going to get anything done if we can't get some kind of consensus.”

The need to come together to deal with this problem seems to be welling up within organized medicine, said Dr. Jack Lewin, CEO and executive vice president of the California Medical Association. “The profession needs a focused and shared vision of what should be done about the uninsured.”

There is also increasing pressure from younger members of the AMA, especially those in the organization's student and residency sections, to place more emphasis on the uninsured, meeting attendees said.

Although the uninsured have been a top priority for primary care groups such as the American Academy of Family Physicans, the American College of Physicians, and American Academy of Pediatrics for some time, the AMA has focused much of its considerable lobbying clout on fixing Medicare's sustained growth rate-based reimbursement formula and capping noneconomic damages in medical malpractice cases. To date, the uninsured problem has ranked a distant third.

These priorities are still the primary pocketbook issues for private practice physicians. Doctors' offices, which operate no differently than many small businesses, are having difficulty keeping their doors open, and are increasingly squeezed by rising overhead and diminishing reimbursement, said attendees.

As physicians' profit margins have fallen, so has their ability to shift the cost of caring for the uninsured, which is why many don't see the uninsured as a separate issue from Medicare reimbursement and liability insurance premiums, said Dr. Anderson.

That perspective may not win over politicians, advised Dr. Price.

“Always talk about the patient, even when you are talking about medical liability reform. I know it's tempting to say that your medical liability premiums have skyrocketed, but I promise you not a member of Congress gives a hoot, not one of them. But they do care that you can't see patients because of that and that your patients can't see specialists because of that,” he said.

However, he and other lawmakers at the conference were not able to provide physicians with much hope that anything substantial will get done on any of these issues this year.

“The remarkable partisanship in which we currently find ourselves is absolutely stifling,” he said.

That partisanship has made it difficult to move on any comprehensive proposals for dealing with the uninsured problem and was on display at the conference.

“When the Republicans ask people to put some skin in the game by encouraging high deductible plans linked with [health savings accounts] what they are really doing is extracting a pound of flesh from the poor and the sick, which will eventually cost us more and leave our nation sicker than it was before,” said Rep. Edward Markey (D-Mass.).

Dr. Price, who served four terms in the Georgia state senate, remarked that the worst day in the state legislature is like the best day in Congress. And it is to the states that physicians may have to look for more immediate solutions.

Reform will ultimately trickle up from states such as Maine, which is in the process of implementing a novel public-private partnership that promises to provide access to health insurance for all of the state's 130,000 uninsured by 2009.

“It's wonderful to be a member of Congress and talk about the issues of the day. But I do think it's important at the end of the day to get something done. My experience has been that people want solutions. They want real answers. They're not looking for 30-second sound bites,” Gov. John Baldacci, D-Maine, said at the meeting. The state's approach, DirigoChoice, was named after the state motto, which is Latin for “We lead.” It was the culmination of a sweeping discussion including physicians and other stakeholders, he said.

“It wasn't done behind closed doors. It was done out in front of everybody … If they were going to buy into it, they needed to have some ownership in the process itself,” said Gov. Baldacci.

Physicians need to play a more central role in reforming the health care system to provide access to more people, said Dr. Lewin.

WASHINGTON — Physicians are increasingly willing to cross party lines on the issue of the uninsured, but convincing lawmakers may be their biggest hurdle.

It's in physicians' best interest to be involved in the debate over health care reform, Rep. Tom Price, (R-Ga.), who is an orthopedic surgeon, said at a national advocacy conference sponsored by the American Medical Association.

“What do you think is holding the current health care system together?” Dr. Price asked the audience. “You. It's the altruism of the physicians of this nation. That's what is holding this system together. It's the only thing holding it together.”

The conference brought physicians together with members of Congress from both parties to talk about the uninsured and other issues. Lawmakers encouraged physicians to participate in finding solutions.

“I am glad to be able to hear what Democrats and Republicans have to say,” said Dr. Charles Anderson, an internist in group practice in Naples, Fla. “We're not going to get anything done if we can't get some kind of consensus.”

The need to come together to deal with this problem seems to be welling up within organized medicine, said Dr. Jack Lewin, CEO and executive vice president of the California Medical Association. “The profession needs a focused and shared vision of what should be done about the uninsured.”

There is also increasing pressure from younger members of the AMA, especially those in the organization's student and residency sections, to place more emphasis on the uninsured, meeting attendees said.

Although the uninsured have been a top priority for primary care groups such as the American Academy of Family Physicans, the American College of Physicians, and American Academy of Pediatrics for some time, the AMA has focused much of its considerable lobbying clout on fixing Medicare's sustained growth rate-based reimbursement formula and capping noneconomic damages in medical malpractice cases. To date, the uninsured problem has ranked a distant third.

These priorities are still the primary pocketbook issues for private practice physicians. Doctors' offices, which operate no differently than many small businesses, are having difficulty keeping their doors open, and are increasingly squeezed by rising overhead and diminishing reimbursement, said attendees.

As physicians' profit margins have fallen, so has their ability to shift the cost of caring for the uninsured, which is why many don't see the uninsured as a separate issue from Medicare reimbursement and liability insurance premiums, said Dr. Anderson.

That perspective may not win over politicians, advised Dr. Price.

“Always talk about the patient, even when you are talking about medical liability reform. I know it's tempting to say that your medical liability premiums have skyrocketed, but I promise you not a member of Congress gives a hoot, not one of them. But they do care that you can't see patients because of that and that your patients can't see specialists because of that,” he said.

However, he and other lawmakers at the conference were not able to provide physicians with much hope that anything substantial will get done on any of these issues this year.

“The remarkable partisanship in which we currently find ourselves is absolutely stifling,” he said.

That partisanship has made it difficult to move on any comprehensive proposals for dealing with the uninsured problem and was on display at the conference.

“When the Republicans ask people to put some skin in the game by encouraging high deductible plans linked with [health savings accounts] what they are really doing is extracting a pound of flesh from the poor and the sick, which will eventually cost us more and leave our nation sicker than it was before,” said Rep. Edward Markey (D-Mass.).

Dr. Price, who served four terms in the Georgia state senate, remarked that the worst day in the state legislature is like the best day in Congress. And it is to the states that physicians may have to look for more immediate solutions.

Reform will ultimately trickle up from states such as Maine, which is in the process of implementing a novel public-private partnership that promises to provide access to health insurance for all of the state's 130,000 uninsured by 2009.

“It's wonderful to be a member of Congress and talk about the issues of the day. But I do think it's important at the end of the day to get something done. My experience has been that people want solutions. They want real answers. They're not looking for 30-second sound bites,” Gov. John Baldacci, D-Maine, said at the meeting. The state's approach, DirigoChoice, was named after the state motto, which is Latin for “We lead.” It was the culmination of a sweeping discussion including physicians and other stakeholders, he said.

“It wasn't done behind closed doors. It was done out in front of everybody … If they were going to buy into it, they needed to have some ownership in the process itself,” said Gov. Baldacci.

Physicians need to play a more central role in reforming the health care system to provide access to more people, said Dr. Lewin.

WASHINGTON — Physicians are increasingly willing to cross party lines on the issue of the uninsured, but convincing lawmakers may be their biggest hurdle.

It's in physicians' best interest to be involved in the debate over health care reform, Rep. Tom Price, (R-Ga.), who is an orthopedic surgeon, said at a national advocacy conference sponsored by the American Medical Association.

“What do you think is holding the current health care system together?” Dr. Price asked the audience. “You. It's the altruism of the physicians of this nation. That's what is holding this system together. It's the only thing holding it together.”

The conference brought physicians together with members of Congress from both parties to talk about the uninsured and other issues. Lawmakers encouraged physicians to participate in finding solutions.

“I am glad to be able to hear what Democrats and Republicans have to say,” said Dr. Charles Anderson, an internist in group practice in Naples, Fla. “We're not going to get anything done if we can't get some kind of consensus.”

The need to come together to deal with this problem seems to be welling up within organized medicine, said Dr. Jack Lewin, CEO and executive vice president of the California Medical Association. “The profession needs a focused and shared vision of what should be done about the uninsured.”

There is also increasing pressure from younger members of the AMA, especially those in the organization's student and residency sections, to place more emphasis on the uninsured, meeting attendees said.

Although the uninsured have been a top priority for primary care groups such as the American Academy of Family Physicans, the American College of Physicians, and American Academy of Pediatrics for some time, the AMA has focused much of its considerable lobbying clout on fixing Medicare's sustained growth rate-based reimbursement formula and capping noneconomic damages in medical malpractice cases. To date, the uninsured problem has ranked a distant third.

These priorities are still the primary pocketbook issues for private practice physicians. Doctors' offices, which operate no differently than many small businesses, are having difficulty keeping their doors open, and are increasingly squeezed by rising overhead and diminishing reimbursement, said attendees.

As physicians' profit margins have fallen, so has their ability to shift the cost of caring for the uninsured, which is why many don't see the uninsured as a separate issue from Medicare reimbursement and liability insurance premiums, said Dr. Anderson.

That perspective may not win over politicians, advised Dr. Price.

“Always talk about the patient, even when you are talking about medical liability reform. I know it's tempting to say that your medical liability premiums have skyrocketed, but I promise you not a member of Congress gives a hoot, not one of them. But they do care that you can't see patients because of that and that your patients can't see specialists because of that,” he said.

However, he and other lawmakers at the conference were not able to provide physicians with much hope that anything substantial will get done on any of these issues this year.

“The remarkable partisanship in which we currently find ourselves is absolutely stifling,” he said.

That partisanship has made it difficult to move on any comprehensive proposals for dealing with the uninsured problem and was on display at the conference.

“When the Republicans ask people to put some skin in the game by encouraging high deductible plans linked with [health savings accounts] what they are really doing is extracting a pound of flesh from the poor and the sick, which will eventually cost us more and leave our nation sicker than it was before,” said Rep. Edward Markey (D-Mass.).

Dr. Price, who served four terms in the Georgia state senate, remarked that the worst day in the state legislature is like the best day in Congress. And it is to the states that physicians may have to look for more immediate solutions.

Reform will ultimately trickle up from states such as Maine, which is in the process of implementing a novel public-private partnership that promises to provide access to health insurance for all of the state's 130,000 uninsured by 2009.

“It's wonderful to be a member of Congress and talk about the issues of the day. But I do think it's important at the end of the day to get something done. My experience has been that people want solutions. They want real answers. They're not looking for 30-second sound bites,” Gov. John Baldacci, D-Maine, said at the meeting. The state's approach, DirigoChoice, was named after the state motto, which is Latin for “We lead.” It was the culmination of a sweeping discussion including physicians and other stakeholders, he said.

“It wasn't done behind closed doors. It was done out in front of everybody … If they were going to buy into it, they needed to have some ownership in the process itself,” said Gov. Baldacci.

Physicians need to play a more central role in reforming the health care system to provide access to more people, said Dr. Lewin.

WASHINGTON — Physicians are increasingly willing to cross party lines on the issue of the uninsured, but convincing lawmakers may be their biggest hurdle.

It's in physicians' best interest to be involved in the debate over health care reform, Rep. Tom Price (R-Ga.), also an orthopedic surgeon, said at a national advocacy conference sponsored by the American Medical Association.

“What do you think is holding the current health care system together?” Dr. Price asked the audience. “You. It's the altruism of the physicians of this nation. That's what is holding this system together. It's the only thing holding it together.”

The conference brought physicians together with members of Congress from both parties to talk about the uninsured and other issues. Lawmakers encouraged physicians to participate in finding solutions.

“I am glad to be able to hear what Democrats and Republicans have to say,” said Dr. Charles Anderson, an internist in group practice in Naples, Fla. “We're not going to get anything done if we can't get some kind of consensus.”

The need to come together to deal with this problem seems to be welling up within organized medicine, said Dr. Jack Lewin, CEO and executive vice president of the California Medical Association. “The profession needs a focused and shared vision of what should be done about the uninsured.”

There is also increasing pressure from younger members of the AMA, especially those in the organization's student and residency sections, to place more emphasis on the uninsured, meeting attendees said.

While the uninsured has been a top priority for primary care groups such as the American Academy of Family Physicans, the American College of Physicians, and American Academy of Pediatrics for some time, the AMA has focused much of it's considerable lobbying clout on fixing Medicare's sustained growth rate-based reimbursement formula and capping noneconomic damages in medical malpractice cases. To date, the problem of the uninsured has ranked a distant third.

These priorities are still the primary pocketbook issues for private practice physicians. Doctors' offices, which operate no differently than many small businesses, are having difficulty keeping their doors open, and are increasingly squeezed by rising overhead and diminishing reimbursement, attendees said.

As physicians' profit margins have fallen, so has their ability to shift the cost of caring for the uninsured, which is why many don't see the uninsured as a separate issue from Medicare reimbursement and liability insurance premiums, Dr. Anderson said.

That perspective may not win over politicians, Dr. Price advised.

“Always talk about the patient, even when you are talking about medical liability reform. I know it's tempting to say that your medical liability premiums have skyrocketed, but I promise you not a member of Congress gives a hoot, not one of them. But they do care that you can't see patients because of that and that your patients can't see specialists because of that,” he said.

However, he and other lawmakers at the conference were not able to provide physicians with much hope that anything substantial will get done on any of these issues this year. “The remarkable partisanship in which we currently find ourselves is absolutely stifling,” Dr. Price said.

That partisanship has made it difficult to move on any comprehensive proposals for dealing with the uninsured problem and was on display at the conference.

“When the Republicans ask people to put some skin in the game by encouraging high deductible plans linked with [health savings accounts] what they are really doing is extracting a pound of flesh from the poor and the sick, which will eventually cost us more and leave our nation sicker than it was before,” said Rep. Edward Markey (D-Mass.).

Dr. Price, who served four terms in the Georgia state senate, remarked that the worst day in the state legislature is like the best day in Congress. And it is to the states that physicians may have to look for more immediate solutions.

Reform will ultimately trickle up from states such as Maine, which is in the process of implementing a novel public-private partnership that promises to provide access to health insurance for all of the state's 130,000 uninsured by 2009.

“It's wonderful to be a member of Congress and talk about the issues of the day. But I do think it's important at the end of the day to get something done. My experience has been that people want solutions. They want real answers. They're not looking for 30-second sound bites,” Gov. John Baldacci (D-Maine), said at the meeting.

The state's approach, DirigoChoice, was named after the state motto, which is Latin for “We lead.” It was the culmination of a sweeping discussion including physicians and other stakeholders, he said.

“It wasn't done behind closed doors. It was done out in front of everybody. … If they were going to buy into it, they needed to have some ownership in the process itself,” Gov. Baldacci said.

Physicians need to play a more central role in reforming the health care system to provide access to more people, Dr. Lewin said. “Either we just sit and wait for a single payer system, or we propose something better,” he warned.

'The profession needs a focused and shared vision of what should be done about the uninsured.' DR. LEWIN

WASHINGTON — Physicians are increasingly willing to cross party lines on the issue of the uninsured, but convincing lawmakers may be their biggest hurdle.

It's in physicians' best interest to be involved in the debate over health care reform, Rep. Tom Price (R-Ga.), also an orthopedic surgeon, said at a national advocacy conference sponsored by the American Medical Association.

“What do you think is holding the current health care system together?” Dr. Price asked the audience. “You. It's the altruism of the physicians of this nation. That's what is holding this system together. It's the only thing holding it together.”

The conference brought physicians together with members of Congress from both parties to talk about the uninsured and other issues. Lawmakers encouraged physicians to participate in finding solutions.

“I am glad to be able to hear what Democrats and Republicans have to say,” said Dr. Charles Anderson, an internist in group practice in Naples, Fla. “We're not going to get anything done if we can't get some kind of consensus.”

The need to come together to deal with this problem seems to be welling up within organized medicine, said Dr. Jack Lewin, CEO and executive vice president of the California Medical Association. “The profession needs a focused and shared vision of what should be done about the uninsured.”

There is also increasing pressure from younger members of the AMA, especially those in the organization's student and residency sections, to place more emphasis on the uninsured, meeting attendees said.

While the uninsured has been a top priority for primary care groups such as the American Academy of Family Physicans, the American College of Physicians, and American Academy of Pediatrics for some time, the AMA has focused much of it's considerable lobbying clout on fixing Medicare's sustained growth rate-based reimbursement formula and capping noneconomic damages in medical malpractice cases. To date, the problem of the uninsured has ranked a distant third.

These priorities are still the primary pocketbook issues for private practice physicians. Doctors' offices, which operate no differently than many small businesses, are having difficulty keeping their doors open, and are increasingly squeezed by rising overhead and diminishing reimbursement, attendees said.

As physicians' profit margins have fallen, so has their ability to shift the cost of caring for the uninsured, which is why many don't see the uninsured as a separate issue from Medicare reimbursement and liability insurance premiums, Dr. Anderson said.

That perspective may not win over politicians, Dr. Price advised.

“Always talk about the patient, even when you are talking about medical liability reform. I know it's tempting to say that your medical liability premiums have skyrocketed, but I promise you not a member of Congress gives a hoot, not one of them. But they do care that you can't see patients because of that and that your patients can't see specialists because of that,” he said.

However, he and other lawmakers at the conference were not able to provide physicians with much hope that anything substantial will get done on any of these issues this year. “The remarkable partisanship in which we currently find ourselves is absolutely stifling,” Dr. Price said.

That partisanship has made it difficult to move on any comprehensive proposals for dealing with the uninsured problem and was on display at the conference.

“When the Republicans ask people to put some skin in the game by encouraging high deductible plans linked with [health savings accounts] what they are really doing is extracting a pound of flesh from the poor and the sick, which will eventually cost us more and leave our nation sicker than it was before,” said Rep. Edward Markey (D-Mass.).

Dr. Price, who served four terms in the Georgia state senate, remarked that the worst day in the state legislature is like the best day in Congress. And it is to the states that physicians may have to look for more immediate solutions.

Reform will ultimately trickle up from states such as Maine, which is in the process of implementing a novel public-private partnership that promises to provide access to health insurance for all of the state's 130,000 uninsured by 2009.

“It's wonderful to be a member of Congress and talk about the issues of the day. But I do think it's important at the end of the day to get something done. My experience has been that people want solutions. They want real answers. They're not looking for 30-second sound bites,” Gov. John Baldacci (D-Maine), said at the meeting.

The state's approach, DirigoChoice, was named after the state motto, which is Latin for “We lead.” It was the culmination of a sweeping discussion including physicians and other stakeholders, he said.

“It wasn't done behind closed doors. It was done out in front of everybody. … If they were going to buy into it, they needed to have some ownership in the process itself,” Gov. Baldacci said.

Physicians need to play a more central role in reforming the health care system to provide access to more people, Dr. Lewin said. “Either we just sit and wait for a single payer system, or we propose something better,” he warned.

'The profession needs a focused and shared vision of what should be done about the uninsured.' DR. LEWIN

WASHINGTON — Physicians are increasingly willing to cross party lines on the issue of the uninsured, but convincing lawmakers may be their biggest hurdle.

It's in physicians' best interest to be involved in the debate over health care reform, Rep. Tom Price (R-Ga.), also an orthopedic surgeon, said at a national advocacy conference sponsored by the American Medical Association.

“What do you think is holding the current health care system together?” Dr. Price asked the audience. “You. It's the altruism of the physicians of this nation. That's what is holding this system together. It's the only thing holding it together.”

The conference brought physicians together with members of Congress from both parties to talk about the uninsured and other issues. Lawmakers encouraged physicians to participate in finding solutions.

“I am glad to be able to hear what Democrats and Republicans have to say,” said Dr. Charles Anderson, an internist in group practice in Naples, Fla. “We're not going to get anything done if we can't get some kind of consensus.”

The need to come together to deal with this problem seems to be welling up within organized medicine, said Dr. Jack Lewin, CEO and executive vice president of the California Medical Association. “The profession needs a focused and shared vision of what should be done about the uninsured.”

There is also increasing pressure from younger members of the AMA, especially those in the organization's student and residency sections, to place more emphasis on the uninsured, meeting attendees said.

While the uninsured has been a top priority for primary care groups such as the American Academy of Family Physicans, the American College of Physicians, and American Academy of Pediatrics for some time, the AMA has focused much of it's considerable lobbying clout on fixing Medicare's sustained growth rate-based reimbursement formula and capping noneconomic damages in medical malpractice cases. To date, the problem of the uninsured has ranked a distant third.

These priorities are still the primary pocketbook issues for private practice physicians. Doctors' offices, which operate no differently than many small businesses, are having difficulty keeping their doors open, and are increasingly squeezed by rising overhead and diminishing reimbursement, attendees said.

As physicians' profit margins have fallen, so has their ability to shift the cost of caring for the uninsured, which is why many don't see the uninsured as a separate issue from Medicare reimbursement and liability insurance premiums, Dr. Anderson said.

That perspective may not win over politicians, Dr. Price advised.

“Always talk about the patient, even when you are talking about medical liability reform. I know it's tempting to say that your medical liability premiums have skyrocketed, but I promise you not a member of Congress gives a hoot, not one of them. But they do care that you can't see patients because of that and that your patients can't see specialists because of that,” he said.

However, he and other lawmakers at the conference were not able to provide physicians with much hope that anything substantial will get done on any of these issues this year. “The remarkable partisanship in which we currently find ourselves is absolutely stifling,” Dr. Price said.

That partisanship has made it difficult to move on any comprehensive proposals for dealing with the uninsured problem and was on display at the conference.

“When the Republicans ask people to put some skin in the game by encouraging high deductible plans linked with [health savings accounts] what they are really doing is extracting a pound of flesh from the poor and the sick, which will eventually cost us more and leave our nation sicker than it was before,” said Rep. Edward Markey (D-Mass.).

Dr. Price, who served four terms in the Georgia state senate, remarked that the worst day in the state legislature is like the best day in Congress. And it is to the states that physicians may have to look for more immediate solutions.

Reform will ultimately trickle up from states such as Maine, which is in the process of implementing a novel public-private partnership that promises to provide access to health insurance for all of the state's 130,000 uninsured by 2009.

“It's wonderful to be a member of Congress and talk about the issues of the day. But I do think it's important at the end of the day to get something done. My experience has been that people want solutions. They want real answers. They're not looking for 30-second sound bites,” Gov. John Baldacci (D-Maine), said at the meeting.

The state's approach, DirigoChoice, was named after the state motto, which is Latin for “We lead.” It was the culmination of a sweeping discussion including physicians and other stakeholders, he said.

“It wasn't done behind closed doors. It was done out in front of everybody. … If they were going to buy into it, they needed to have some ownership in the process itself,” Gov. Baldacci said.

Physicians need to play a more central role in reforming the health care system to provide access to more people, Dr. Lewin said. “Either we just sit and wait for a single payer system, or we propose something better,” he warned.

'The profession needs a focused and shared vision of what should be done about the uninsured.' DR. LEWIN