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Up Front: Chief Medical Editor's Page | May 2010

Lessons Learned

We ophthalmologists should draw several lessons from the passage of health care reform.

No. 1. Define the issue. As I have said before, although I strongly believe that some level of universal coverage should be a goal of our society, I question whether it is an absolute right, as are life, liberty, and the pursuit of happiness. Should some citizens be required by law to supply health care to the rest? It could make sense if affordable, but this year, only one-half of households in the United States will pay income tax.1

No. 2. Communicate and work together. I cannot think of a more important issue to doctors in recent years than health care reform. Our professional societies present themselves in Washington as our representatives. I wish they had reached out more to their members to see what we supported. Although our peers on the discussion boards seemed to be overwhelmingly against the bills, even now, I suspect no one really knows what the majority of ophthalmologists wanted. That is a shame.

No. 3. Demand complete, fair comparisons. Much was made of how our health care system fails compared with European models (ie, higher costs and a lack of universal coverage). That is a fair point, but Europe also has far fewer lawsuits, a quicker and less expensive approval process for drugs and devices, and a clear pathway for citizens who wish to bypass the government and pay for what they deem better care. Our new system imposes financial penalties on states with tort reform.

The American Association for Justice, formerly the Association of Trial Lawyers of America, sent a letter of congratulations to its members on the passage of this bill.2 I did not get a letter of congratulations from my medical societies. I believe defensive medicine exacts a significant cost, as physicians are faced daily with the choice of risking their careers versus ordering one more test. Plus, I see no change to our regulatory pathways or patients’ access to balance billing and self-paid care.

No. 4. Offer a better option with everyone on message.The Democratic proposal was roundly attacked and, according to the polls, did not have the support of the majority of the people. No clear, published Republican alternative, however, was made known. To the people, the Republicans became the party of no. Then, Anthem Blue Cross, California’s largest insurance firm, disclosed nearly a 40% increase in some customers’ premiums just as the proposal was coming to a vote. What a gift to the Democrats!


No. 5. Remember that it is usually about money. I do not believe health care reform in its current form will save the United States money, but that is how the package was sold. The total US debt will amount to more than 100% of the national economy as early as 2012.3 I suspect that we can afford two of the following: (1) universal health care and social programs, (2) our superb military, and (3) a balanced budget. Which do you choose?

No. 6. Know thyself. As physicians, are we taken seriously? Were our morale and economic interests factors in the equation? I have never seen physicians’ morale lower. Cataract reimbursement has plummeted from $8,000 to $600 during my career, while technology, overhead, and my staff’s wages have risen. Are ophthalmologists a significant voting block, source of campaign funds, or lobbying force?

My final comment is that health care reform is the law now, and I do not condone some of the ways that people are resisting it. I am against offensive language, racism, and threats against members of Congress, whatever your position on this legislation. If you are unhappy, make the health care bill’s passage a major factor in the November elections.

Stephen G. Slade, MD
Chief Medical Editor

  1. Ohlemacher S.Nearly half of US households escape fed income tax.Associated Press. http://finance.yahoo.com/news/Nearly-half-of-US-households-apf-1105567323.html?x=0&.v=1.Published April 7,2010.Accessed April 26,2010.
  2. Tarricone A.AAJ’s healthcare campaign in review.American Association for Justice. http://www.justice.org/cps/rde/xchg/justice/hs.xsl/11384.htm.Published March 26,2010.Accessed April 27,2010.
  3. Knoller M.National debt up $2 trillion on Obama’s watch.CBSNews Politics.http://www.cbsnews.com/8301- 503544_162-20000576-503544.html?tag=contentMain;contentBody.Posted March 16,2010.Accessed April 20, 2010.
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