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Doctors for America: key group in driving health care reform

On March 22, the day after the House of Representatives passed the health care reform bill and ahead of Senate action, thousands of doctors, nurses, medical students and other health professionals marched in Washington in support of reform.

04 Apr 2010

By Dr Lesley Russell

Behind the public dramas played out on the floors of the House of Representatives and the Senate during the final votes for President Barack Obama's health care reform legislation lie a raft of other stories, equally dramatic and heartfelt, about the behind-the-scenes players who helped bring this landmark bill into reality.  Key among these are doctors' groups and medical organisations.

Previous attempts at health care reform, most recently during the Clinton Administration but stretching back for decades, have seen organised medicine clearly, even defiantly, on the other side of the issue.  Twenty years ago the only doctors who could be counted on to support such reforms were paediatricians, largely because they knew keenly what it meant for the health insurance coverage and health care costs of everyone in a family when a young child was diagnosed with an inherited disorder or a serious chronic condition.

But by the time Barack Obama emerged as the Democratic Presidential candidate, the US health care system was so badly broken for so many patients and so many health care providers that he was able effectively to reach out to the medical profession and tap into the fundamental emotion that drives the desire to work in medicine - doctors care about their patients.

Every doctor in America who works in a hospital emergency room knows what it is like to be confronted with patients who present with conditions that could have been treated in the community, if only patients could afford the cost. Worse, many emergency room doctors have had to obey the law and treat an uninsured patient who, once stabilised, is then shunted off to another facility that is willing to provide the uncompensated care needed.  Every specialist knows that he or she must spend hours to help patients, often those who are mortally ill, and their families fight the insurance funds to ensure that they get the required treatments.

So it was that, this time around, the medical societies and professional bodies were willing allies and keen supporters of the President's health care reform proposals; they recognised that the current situation was unsustainable, economically and socially, and that health care reform was crucial for their patients and for them. 

Initially, some were critical that the support of the American Medical Association and some specialist colleges was contingent on a fix to the Medicare reimbursement rate that, thanks to a legislative hangover from the Bush Administration, is due to drop 21% in 2010. But, when that provision was taken out of the legislation (it will be done independently, at a cost of more than $200 billion/10 years), their support remained.

The most effective doctors' group in the campaign for health care reform has been a grassroots organisation called Doctors for America (DFA). It grew out of a presidential campaign group originally called Doctors for Obama which supported his election platform. But since the election it has grown by leaps and bounds from a body focused on getting Obama elected to one driven by the need to deliver on his key election promise.

The strength of DFA is that it operates at a grass-roots level. Busy but committed doctors across the US are willing to write editorials, visit their lawmakers, talk to the media and show up, singly and en masse, in their white coats and scrubs, to make their case. They have energy, they have credibility and because of that they are listened to and consulted. My own primary care doctor is an active member. He proudly wears a button that says "I support health care reform". His patients love him; I always return his emails.

When a Utah congressman said he would vote for health care reform if 500 Utah doctors said they supported the bill, somehow 500 doctors rallied at his office. (The Congressman, who shall remain nameless, reneged on his bargain and voted against the bill!). 

President Obama has had DFA representatives to the White House on a number of occasions. The influence of DFA is such that they will continue to be players as the implementation of health care reform gets underway. Policy changes now will happen with these doctors, not to them.

On March 22, the day after the House of Representatives passed the health care reform bill and ahead of Senate action, thousands of doctors, nurses, medical students and other health professionals marched in Washington in support of reform. Participating groups included DFA, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians, health unions and medical students' associations.

It was an impressive sight. I live in hope that we will see its equivalent here in Australia in support of needed health care reforms.

Dr Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy, The University of Sydney/Australian NationalUniversity, and a Research Associate at the US Studies Centre at The University of Sydney. She is currently a Visiting Fellow at the Center for American Progress in Washington, DC.

Published: 04 Apr 2010