Is the time finally right for health reform?

While leaders of the AMA, AAFP, and American College of Physicians all support Obama's goals and what he's done so far, no one is underestimating the tremendous political hurdles-or the potential for opposition from segments of the physician community.

Key Points

"We're past the 'Harry and Louise' moment," said the Rhode Island Democrat, referring to the insurance industry ad attacks that helped derail President Clinton's reform efforts 15 years ago. "We're at the Thelma & Louise moment." That was the movie that ended with the two heroines driving off a cliff.

"What we have now isn't working for anyone," agrees Nancy Nielsen, MD, president of the American Medical Association, which opposed the Clinton plan. "There's a clear message from all the stakeholders that we really have to have change. I get a feeling of optimism that people want to be constructive and change will happen."

Not everyone is so sure. Obama has set out broad principles of expanding coverage, controlling costs, and improving quality, and asked Congress to take the lead in crafting legislation to carry them out. Medical leaders call him politically shrewd for taking that approach, rather than handing down his own detailed plan, as Clinton did. But congressional Democrats and Republicans are far from agreement.

At a White House summit on healthcare in March, Obama called the "exploding" cost of healthcare one of the greatest threats to families, businesses, the budget, and the economy. "This time, there is no debate about whether all Americans should have quality, affordable healthcare-the only question is how?" He warned that "there will be no sacred cows in this discussion . . . and those who seek to block any reform at any cost will not prevail this time around."

"We don't have a healthcare system; we have a set of fragmented interest groups looking out for their own interests," laments Chuck Kilo, MD, a Portland, Oregon, internist who wants a national health insurance system similar to Sweden's. "How can we tolerate having one-sixth of our population with no insurance? Doctors haven't spoken up and pounded our fists. We only do that when something threatens our own incomes."

Kilo predicts that high-earning specialists are more likely to resist changes than primary care physicians. But some primary care doctors also balk at what Obama and congressional Democrats are prescribing.

"This is a socialist, single-payer government healthcare program, and it will be no better than the best day in Canada or England," says George Watson, DO, a Wichita soloist who practices preventive and occupational medicine and sits on the board of the conservative Association of American Physicians and Surgeons.

The hopeful news for Obama, however, is that many business leaders say the U.S. system needs to become more like Canada's and England's in terms of quality and cost-effectiveness-or else this country will continue to lose economic ground.

A new report by the Business Roundtable, which represents CEOs of major companies, says the U.S. spends 75 percent more per capita on healthcare than Canada, Japan, Germany, Great Britain, and France-but lags well behind those countries on 17 key health measures.

The U.S. will spend an estimated $2.5 trillion on healthcare this year-more than $8,000 per person-making up 17.6 percent of our GDP and growing. Yet an estimated 46 million Americans were uninsured and another 25 million were underinsured.

The Business Roundtable report says higher U.S. health spending siphons off economic resources without delivering a healthier workforce. Still, the Roundtable opposes a government-run system.

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