Physicians urged to engage in health care reform initiatives

American College of Cardiology (ACC) President Steven E. Nissen, MD, asked physicians and the organization to examine their role in the national debate on health care reform. His remarks came during his opening address to ACC members.

"We could sit on the sidelines and wait for the legislative branch to arrive at a solution for the problem. We could be reactive, offering commentary and critique as various plans are introduced, we could defend our economic interests by making certain we recover our share of the increased expenditures," said Dr. Nissen, who is chairman, department of cardiovascular medicine, Cleveland Clinic, Cleveland. "Or we could be proactive: vigorously engaging in the process; proposing innovative solutions; and passionately advocating on this issue to our colleagues, patients, the media, and in the halls of congress."

The problem is not a lack of health care expenditures, with $2.1 trillion, or 16% of the U.S. gross national product, being spent on health care in 2006, Dr. Nissen said. Despite this, the country ranks 46th in life expectancy among all nations and has an infant mortality rate 39% higher than Belgium and 56% higher than Germany.

"We fail because we provide health care unevenly," he said. "We care for the poor and uninsured through cost-shifting." This practice ultimately leads to poor outcomes and creates one level of health care quality for the advantaged and one for the disadvantaged."

Dr. Nissen acknowledged that cardiologists are part of the problem and he encouraged the ACC to adopt and promote "appropriateness guidelines" to consider the cost of procedures and treatments that do not maximize overall benefits before widely advocating them in practice guidelines. For example, advocating expensive imaging tests for all Americans older than age 45 with the purpose of detecting subclinical atherosclerosis results in billions of dollars being spent recklessly. "We must use technology wisely," he said.

The Bush Administration’s current proposals are useful but address issues for some working Americans and leave large gaps in coverage for tens of millions of others, Dr. Nissen said. Various state initiatives, such as those proposed in California and Massachusetts, are appealing. "In my view, the major value of state plans is to raise awareness and serve as an incubator for ideas that would optimally be implemented nationally.

"A few reform advocates continue to support a universal health care system," he said. "Because this approach limits individual choice, it is not likely to gain broad national support."

Physicians and organizations such as the ACC should lead the way in the health care reform dialogue. "No one better understands the needs of our patients than our profession. We understand health care in ways no politician can possibly master and we have creative energy to be a key source of innovation in seeking solutions to these daunting problems," Dr. Nissen said.