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Published 5/1/2010
S. Terry Canale, MD

Success is getting what you want; happiness is wanting what you get

So President Obama got what he wanted, a healthcare bill. This was the first major healthcare bill to pass Congress in a long time. It seems as if the politicians were more concerned with successfully passing any healthcare bill and making history than they were with what was actually in the bill and what the cost will be.

The good news is that more people in the United States will be covered by health insurance, even though their access to quality medical care may be less and more costly. But it seems that many groups aren't happy about several aspects of the final legislation.

So we lost. I've lost before. I played football on one of the most successful high school teams in the state of Tennessee, we never lost a game. Then I graduated and entered the University of Virginia and played on the worst Division 1 college team in America. We tied the national losing record at 28. We lost so often that I was a celebrity! Finally, we beat William and Mary, but I think Mary played defense. So I know how to win and how to lose. Sometimes you have to lose to win! But I'm not a good loser.

So, now that healthcare reform is law, what's changed?
I guess when the smoke clears, there may be some happiness because (1) more people will have medical insurance coverage and will be able to pay for it, (2) insurance companies will be put in their place and required to do better, and (3) they say that hospital costs will be lowered.

Reform needs reforming
The AAOS, the Alliance for Specialty Medicine, and other coalitions opposed one or more parts of the legislation, particularly in the following six major areas that may have a negative impact on our ability to provide affordable, quality, specialty care to patients:

  • The creation of a Medicare advisory board, not accountable to Congress or anyone else
  • No provision to reform the flawed Medicare physician reimbursement formula
  • Mandatory participation in the flawed Physician Quality Reporting Initiative
  • Budget-neutral payment increases to some physicians that result in payment cuts to others
  • Giving patients direct access to physical therapists
  • Restrictions on physician ownership of hospitals

So what's next? How about we shake hands with the "successful" and come out fighting!

I don't know much about Washington, DC, but I do know that many times it's a large leap from passing legislation to actually putting legislation into practice. So now is the time to work on the process. Sometimes you have to let go to "hold on." We may have lost the "war," but we may still be able to win a few "battles."

We may not have been as successful in shaping the initial legislation, but we may be able to help shape whatever ultimately gets implemented if we are diligent, continue to work with the Council on Advocacy, the office of government relations and our new medical director William R. Martin III, MD, and our lobbyists to make the best hand possible out of the cards we've been dealt.

In this issue of AAOS Now, on pages 36-39, you'll find excellent summaries of what the healthcare reform law means to orthopaedists and our patients, as well as a timeline of when key provisions of the act go into effect. I encourage you to read these advocacy articles so you are informed about ongoing efforts to shape reform.

Now is not the time to throw in the towel. We need to be involved in the implementation process. We need to work through the court system as states' Attorneys General challenge the constitutionality of the bill. We need to respond to the Centers for Medicare & Medicaid Services and other regulatory agencies. We need to work on electing senators and representatives who share our same convictions in the 2010 and 2012 elections so this healthcare bill can be repealed or overhauled.

It's not over yet
Actually, in the past, the orthopaedic community has not done too badly in helping to shape the system. For example, grants from the AAOS State Health Policy Fund have helped bring about medical liability reform in several states, including Nevada and Oklahoma. Although the sustainable growth rate (SGR) formula for Medicare physician payments is still in effect, we're closer than ever to achieving a permanent fix, and Congress continues to postpone the scheduled 21 percent pay cut.

More importantly, leaders in the orthopaedic community are being recognized. An orthopaedic surgeon serves as the director of the department of health and human resources in Virginia; another serves in the House (and others are determined to run for Congressional seats); and another serves in the Senate. These voices, as part of the government, will be heard. The Orthopaedic Political Action Committee has raised more funds than ever before to support candidates who share our views.

Healthcare reform may be law, but polls show that 52 percent to 62 percent of Americans do not favor it. With such widespread discontent, new leadership may emerge in the next two elections (2010 and 2012) that share our convictions, giving us the opportunity to reshape legislation.

I was always told that God made time so everything wouldn't happen at once. But we can't let time make us complacent or discourage us. Now is the time to get and stay involved, not only to influence the elections in this year, but to get our message out and influence outcomes in 2012 and years to come. What will it be, "Will we remember?" or "We WILL remember!"?

If we are willing to do the work by being involved, we may be successful in achieving additional reforms that truly benefit our patients. If we are not, then we should learn to be happy with what we got.