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This is an archive page. The links are no longer being updated.REMARKS BY: TOMMY G. THOMPSON, SECRETARY OF HEALTH AND HUMAN SERVICES PLACE: THE AMERICAN MEDICAL ASSOCIATION, CHICAGO, ILLINOIS DATE: JUNE 17, 2001
I'm also pleased to see my old friend and the incoming chair of your Board of Trustees, Dr. Tim Flaherty.
The AMA has built one of the most impressive legacies of any policy group in the country. Your work in advancing the quality of care Americans receive has been both substantial and consistent, not an easy combination to achieve in the give-and-take of politics. The House of Delegates has developed the policies that have guided the AMA's efforts, and I want to thank you both for your historic and your current contributions.
The practice of medicine has come a long way since 1767, when a Dr. Thomas Wise of Philadelphia advertised what he claimed was his capacity for healing cancerous cysts without surgery and proclaimed his ability to do so, in his words, "with small expense and small pain to the patient." I would like to have met Dr. Wise and maybe talked to a couple of his patients.
According to the historian Benson Bobrick, our colonial ancestors believed in administering saltpeter for everything from measles to headache. Saltpeter is now used as a source of fertilizer. Kidney beans were advocated as a remedy for kidney stones. And sassafras, a root now used in making a type of tea, "was regarded as a kind of miracle herb."
We've come a long way. But we have a long way to go. And since its founding in 1847, the AMA has been a pioneer on the journey of medical progress and continues to open new paths to better care for the people of our country.
So today, I want to talk with you about what we can do together to keep transforming the way the American people receive health care.
First, let me discuss some of the major changes we are making at the Department of Health and Human Services. During my first four months at the department we've announced a number of initiatives that directly impact you and your profession. The first wave of reforms at the Centers for Medicare and Medicaid Services; our move to bring some overdue changes to the regulatory system; and a move to help each of you provide a higher quality of care for your patients.
I'd also like to take a couple of minutes to outline a few of the projects we have in development and I'll discuss the President's view of how we should ensure that patients have the protections they need through a Patients' Bill of Rights.
Now, I know that there is one federal agency that doctors love to hate, HCFA. As a governor, it was the federal agency I loved to hate, too. Well, as of Thursday, that organization no longer exists. Along with the new administrator, Tom Scully, I announced the first wave of reforms to that organization. HCFA will now be known as the Centers for Medicare and Medicaid Services. That new name intends to reflect a new culture of responsiveness and renewed efforts to reach out to patients and providers like you. To give the agency a new direction, a new spirit, it is necessary to give it a new name, one that truly reflects the agency's vital mission to serve millions of Medicare and Medicaid beneficiaries across the country.
As part of the renaming, we are reorganizing the CMS around three centers to clearly reflect what precisely it does and how it serves millions of Americans:
The Center for Beneficiary Choices will focus on the Medicare + Choice program and provide beneficiaries with the information they need to make informed choices about their health care.
The Center for Medicare Management will focus on the traditional fee-for-service Medicare program. The Center for Medicaid and State Operations will focus on programs administered by the states, including Medicaid, SCHIP and insurance regulation.
Tom and I are excited about these changes, and there are more coming. These programs are vital to millions and millions of Americans, and our job should not be to make it more difficult for you to provide medical services to those beneficiaries but to make it easier.
As I've already mentioned, the medical horizon is filled with new treatments and new technologies. But the landscape before that horizon is clotted with reams of paper, bundles of rules and heaps of regulations. That frustrates me even as I know it aggravates physicians. You were not called to be file clerks or accountants or to have your time and resources drained away by filling out form after form.
At the Department of Health and Human Services, we're forming a new regulatory reform group that will look for regulations that prevent physicians and other health care providers from helping people in the most effective way possible. This group will determine what rules need to be better explained, what rules need to be streamlined and what rules need to be cut altogether. I'd be remiss in not thanking the AMA for your support of this new initiative. We need your continued support and counsel to make it work, and I look forward to working toward this end with you.
The good news is that despite excessive regulations, new technologies afford us the hope of reducing the paperwork burden as it exists today. The growing movement toward a "paperless" medical environment encourages that hope. More extensive use of computers for the entry of prescriptions and medical records are helping physicians keep track of patients' histories with electrons rather than with paper and ink and thereby enabling you to provide a higher quality of care.
Each of you spent many years training to become highly skilled as physicians. America needs you practicing medicine, not pushing paper.
Lifting the excessive regulatory burden and reducing the quantity of paperwork on physicians is one component of our aggressive effort to improve the quality of health care and patient safety. Like you, we want patients to receive the best care possible, and the new CMS is going to be your partner in achieving this goal.
That's why HHS is investing in measures to help us better identify specific practices that will improve patient care across the board.
We're not interested in blaming doctors for errors and quality problems. We simply want to gain a better understanding of what is occurring and how to improve the care patients receive.
Looking forward, I will also be asking you for help on a very important initiative concerning preventive health care. We look at things backward in this country; we wait until people get sick, and then provide them with care. I think one of the most important ways we can improve the quality of care in this country is to discourage debilitating diseases like diabetes and asthma in the first place. So I will be calling on all of you for your ideas, your suggestions and your help in communicating to your patients the simple steps we can all take to live healthier lives: don't smoke, don't overeat and exercise.
Improving the quality of care in this country is a long-term task that will require sustained commitment. The federal government cannot improve the quality of health care on its own. We need to collaborate with state governments, stakeholder organizations, private sector partners and, most especially, physicians like you.
By making a mutual commitment to quality, and building on the important work we have already done together, our health care system can more consistently provide the safe, high quality care it is capable of delivering.
Certainly one of the most significant ways of providing quality care is through ensuring that patients are protected from a medical bureaucracy that can be insensitive to patients' needs and difficult for patients to understand. Of course, I'm talking about the various measures pending before Congress that seek to provide a "bill of rights" for patients. All of them have some good ideas. Some of them also contain serious weaknesses.
First, let me underscore that we agree far more than we disagree. President Bush is committed to making sure that patients receive genuine protections. We are eager to work with you to that end. We want to join with you in finding a place where our minds and legislative proposals can fully meet. And we believe we're 95 percent there.
The President and I were both governors. In our respective states, Texas and Wisconsin, there are already patient protection laws that contain provisions to enable patients to appeal denials of health care services by requiring reviews of provider decisions. Our laws require that medical coverage decisions be resolved quickly, with minimal cost, instead of dragging out into expensive litigation. And in Wisconsin, as in Texas, Republicans and Democrats alike reached a common accord.
The President and I are proud of what we helped accomplish in our home states, and we want to achieve the same results for the people of our country nationwide. There is broad bipartisan support for the principles the President has said must be in the kind of bill he will sign.
For example, all of us want a federal Patients' Bill of Rights that provides every American strong patient protections. Because many states have passed patient protection laws that are appropriate for their states, deference should be given to these state laws and to the traditional authority of states to regulate health insurance.
In addition, every patient should be able to get the treatment he or she needs, period. This includes emergency room care at the closest emergency room possible and the right to see a specialist when a specialist is needed.
The care you receive shouldn't be contingent on the guesswork of an actuary or accountant. And potentially lifesaving clinical trials should be open to anyone whose regimen of standard treatment doesn't work.
Patients also deserve a rapid medical review process when they are denied the care they believe they need. President Bush has said he wants to sign a bill that includes a binding, independent review process. If a health plan denies someone health care, that person should be able to appeal to an impartial review panel of physicians and get a quick, thorough response. This would put decisions about care in the hands of those best equipped to make it, men and women like yourselves.
So despite our disagreements, we share some important commitments. We need to build on these commitments to overcome our differences.
Of course, our disagreements are real, particularly regarding legislation that includes high caps on damage awards, which would invite lengthy trials and more expensive health costs. And when health insurance companies and providers are sued, the corporations and small businesses that use them should not be held liable for their mistakes. That could well do serious damage to the voluntary, employer-based health care system we depend on.
We also should prohibit punitive damages against health plans even when they comply with independent medical review. Under the Kennedy-McCain bill, for example, the $5 million punitive damage cap extends only to federal lawsuits. Other damage claims have no caps whatever. It would also be a serious mistake to make state and federal jurisdictions so intertwined that trial lawyers could shape their pleadings to get into either state or federal courts or, in many cases, both.
Under the Kennedy-McCain plan, more lawsuits against employers and insurance companies will surely result in others being sued. The possibility for state and federal lawsuits against physicians under this provision is real and dangerous.
But with all this, let me emphasize that by drawing attention to our differences, I am not also drawing a line in the sand. None of our disagreements are insurmountable. We must not view them as logs jamming a river but as planks to build a bridge. We all need to join together in a successful effort to build that bridge across the things that currently divide us. As we do, we can, together, provide for the real, pressing needs of Americans of every walk of life who should have access to quality, affordable care in a timely manner.
On his desk in the White House, President Reagan kept a little sign that captures the spirit we all need to have as we address this issue. It said, "There is no limit to what you can accomplish if you don't care who gets the credit." President Kennedy put it another way: "Defeat is an orphan, but victory has a thousand fathers."
Let's all be fathers and mothers of a patients' protection measure that will ensure the kind of care I know you, as physicians, care deeply about providing and that President Bush and I want to enshrine in law.
We share that goal. We must undertake that task. I look forward to working with you as, together, we accomplish it. And I also look forward to partnering with you in the other critical health care and scientific challenges facing our country. Together, we can open the new era of medicine to everyone. Thank you very much.
Last revised: June 26, 2001
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