President's Page

President's Page
February 2008

Installation Address:
Focusing on the Uninsured

As your new president, I have 2 main goals. One is to build on the strengths of our society and continue the good work that has preceded me. The second is to work for a solution for the plight of the uninsured.

That first goal will be easy. Dr Tim Norwood has left our Society in good shape. Under his leadership, we are implementing a Strategic Plan that reorganizes many aspects of our Society. For example, we will have a new Communications Committee that, working with our Membership Committee, will be coming up with new options for connecting with our members, especially the younger and more electronically savvy ones. We are the second largest county medical society in the nation, second only to the great Harris County, and we are growing daily. Our membership is up to 6200 the last time I checked. We have the best county medical society staff in the universe. We are blessed with a growing number of new and eager young members…and are they smart! Our future is in good shape with such young members as Kelli Watkins, Roger Khetan, Lee Ann Pearse, and Steven Hays, among many others. Something has happened under Dr Norwood’s steady leadership. I have seen new energy and new ideas such as I have not seen before. We are in good shape!

My second goal, to work for a solution for the plight of the medically uninsured and underinsured, will be more difficult. However, we must attack this problem. There is a freight train called Universal Health Care, barreling down the tracks right now. It will do us no good to stand on the tracks with our hands up, yelling “Stop!”

Health care in our country is a mess. To say “the system is broken” is wrong. We have no system. For those of us with good insurance, we have the best medical care in the world. Foreigners flock here for care. But for the less fortunate, we do a dismal job; we rank in the 20s and 30s for most parameters of care as measured by various independent organizations. There are at least 47 million Americans without coverage and at least that many with inadequate coverage. The biggest tragedy is that many of these persons are children. A country that cannot provide health care and education for all of its children is a country with a poor future.

Cost is obviously the largest issue when discussing our predicament. Costs are so high now that only about 37% of small businesses in Texas offer health care to their employees. In my office, we pay over $6000 a year per covered employee for health care; I bear 80% of this cost. This is a crippling burden for most businesses and the costs just keep rising. The causes are many and the usual villains include: greedy insurance companies, inefficient hospitals, medical malpractice, the over-specialization of medicine, the high cost of pharmaceuticals, overuse of expensive technology, lack of communication within our healthcare networks, government regulations, and expensive end-of-life care. Usually left off the list are some huge contributors: unhealthy lifestyles of our citizens and our society’s unreasonable expectations of medical care. It’s a daunting list.

Here in Dallas County, we have our wonderful Project Access Dallas; it is an innovative, award-winning charitable healthcare delivery system that helps many of our less fortunate. However, it is only a drop in the bucket. The Texas Medical Association adopted a resolution at our last House of Delegates to make universal coverage for children one of its goals; SCHIP helps but does not meet all the needs of our children. Our county hospital system (Parkland) is a safety net for many but it is overwhelmed with patients and underfunded. In the long run, we will need to face the fact that these programs are inadequate and we need to lock in new and efficient systems and/ or find new money.

You are probably wondering why I, a simple family physician from Dallas, Texas, am talking to you, a small group that overall has little influence. Why not leave it to the AMA, a much more powerful group? It is because large ideas all start in small places and all politics is local. Small groups are much more nimble. The AMA is stuck in mud on this issue. Our excellent and nimble TMA is working hard on this problem as we speak, but again, large groups move at a slower speed.

We physicians are in an ideal situation to help drive a solution. Along with our clergy, we are still the most respected profession. We know far more than anyone else about health care and especially about patient behavior. And our patients know we do care about them. Our patients do not know the dire situation of the profession of medicine. They also do not know that we are aligned with them. We need to educate them.

All of us need to become teachers. We must tell our individual stories. My patients regularly tell me they know that I make huge amounts of money. They need to know this is not true. They need to know I work 65 hours a week, and if I worked 40 hours a week and took a month off every year, I would quickly be bankrupt. They need to know I have 12 employees, rent, taxes, insurance payments, and an expensive computer system. They need to know I am battling with 500–600 insurance payors all the time. They need to know that if Medicare continues to reimburse me at rates that do not keep up with expenses, I will be forced to stop seeing Medicare patients. You need to tell your patients your story.

We also need to stop hiding our heads in the sand and become active on the political front. This does not mean you need to go and harass Pete Sessions; we can leave that to Lee Ann Pearse. But you can do something to make your voice heard by your elected officials. Send them a letter, make a phone call. They do listen. And by all means, support our political action committees—TEXPAC and HealthPAC.

I will be asking our Board to form an Ad Hoc Committee on the Uninsured and Underinsured. I envision it as a small think tank of interested Dallas doctors. I expect a diversity of opinion but I expect some solid recommendations.

I am a fan of our founding fathers, especially John Adams, Ben Franklin, and Thomas Jefferson. They invented democracy. Winston Churchill is known for popularizing the expression that democracy is the worst political system except for all the others. But Ben Franklin beat him by 150 years when he stated that, and I paraphrase, he was distraught by the animosity of our Continental Congress but surprised and pleased by results, the Constitution of the United States, a triumph of compromise and wisdom. We need men and women of intellect, courage, and integrity to do for health care what our founding fathers did for our country. We can work it out.

So, as the freight train of Health Care Reform comes barreling down the track, we need to ensure there are two drivers up front in the engine—our patients and their physicians. All the rest can sit back in a boxcar—the politicians, insurance company executives, hospital administrators, economists, and lawyers. Only then will we find the right solution for the health of our patients and our profession.

I love being a doctor and I love our profession. I know most physicians feel the same as I. As we move forward together to meet the many challenges we face, let us remember this and remember always to keep our patients’ welfare as our No. 1 priority.

As your president, I promise to listen well and work hard. It’s going to be an exciting year. Thank you.

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