Opening Remarks by Lydia Vaias, MD, MPH
A very brief but loving shout out to Paul Ambrose. Paul was my LAD, my friend, and my teacher. Paul died on 911. Paul's spirit has pervaded everything we have done this year and I know he is right here in the thick of things. I couldn't be doing this without him.
I want to talk about three things today.
What is the problem?
Why NPA?
Why NOW?
There are some fundamentally flawed beliefs in our country these days-ideas twisted by spin-meisters, floated, and repeated so many times and in so many ways, people are beginning to believe they are true. The goal I believe is to first change people's beliefs, then you can change policy without much of an uprising.
Here are a few of my favorites...
Everyone has equal opportunity.
All problems can be solved by market forces and competition.
Tax credits will make people buy health insurance.
Sick uninsured people will evaporate rather than showing up in our emergency rooms.
Diseases discriminate and stratify based on national boundaries, income, and social status.
Everyone is entitled to everything we have to offer in terms of health care, all the time and immediately.
We do not ration healthcare.
The U.S. has the best healthcare in the world.
High deductible health insurance will make people stop frivolously wasting healthcare and make healthcare cheaper and people healthier.
A $250,000 cap on pain and suffering will solve the malpractice problem.
Medicaid is used by ungrateful people who are cheating the system, most of them illegal aliens.
Doctors are not in the least bit influenced by drug company gifts.
Guns don't kill people, people kill people.
The quality and outcome of your healthcare is the same regardless of your ethnicity or economic status.
The AMA represents all doctors.
Physicians are greedy, self-serving elites who cannot be trusted to act in their patients' best interests.
I disagree with these things and I am mad. The soul of my country, the integrity of my profession, and my own civil rights are being crushed under a system that has turned everything we do and everything we are into a market good to be analyzed, packaged, and sold. What we need to acknowledge and say very clearly is that none of these things is for sale.
There is a void in organized medicine today. No multi-specialty medical association has stepped forward to unite and represent the thousands of physicians who believe that repairing America's broken health-care system should not be approached as a zero-sum endeavor, with physician interests pitted specialty against specialty and even against the interests of the populations we serve. We are no longer trusted to act first on what is best for out patients.
There is a void in organized medicine today. No multi-specialty organization has had the courage say to pharmaceutical companies: stop bribing American physicians, stop creating diseases to make a market for a drug, stop pushing the overuse of antibiotics that drive the evolution of infectious agents into super-bugs for which we have no treatment.
There is a void in organized medicine today. No multi-specialty organization has pointed out the obvious: that the basic premise of how insurance works is that risk is spread across a wide pool. The many pay for the few-the guarantee being that it will be there for you too someday when your time comes, as it will for us all. To limit, cherry pick, narrow an insurance pool for the sake of profit only hurts us all in the end. Just because we stop paying doesn't mean we stop needing.
There is a void in organized medicine today. No multi-specialty organization has shouldered the responsibility to look beyond the self-serving issues of reimbursement and malpractice and truly prioritized with their money, resources, and political muscle what is best for the health of our patients and our nation.
There is a void in organized medicine today. No multi-specialty organization has pointed out the basic truth that healthcare is not a normal market good. No matter how much people try to make themselves educated consumers, they will never be able to shop for healthcare like they shop for cars. For as much as market forces are trying to make our profession conform to market models, the skilled and excellent delivery of care will always be an art. Real healing will always be a combination of training, technology, drugs, and love. Diagnosis will always be the touching, the laying on of hands, the look, the smell, the feel of the human body that gives away the subtle clues that one only learns with experience, practice, and time. It is what draws us to this profession. It is what patients expect. It is what we are forgetting.
It can all make one rather despairing, can't it?
Why the NPA is the Answer:
The National Physicians Alliance accepts the challenge.
We believe the antidote to despair is action.
Ten years ago when I was the AMSA President, our house was broken into and all of the few valuable things I owned were stolen. I was bereft and paralyzed with sadness. For whatever reason, I decided to become Nancy Drew. I began interviewing neighbors, following leads, calling the police regularly with my findings and theories. Amazingly, without actually accomplishing anything, I began to feel better, just by the act of doing something rather than being a victim letting this happen to me. They found my things out of sheer luck and no thanks to me. It almost didn't matter.
The antidote to despair is action.
Sixteen months ago I traveled to New Mexico to work on the presidential election. I was crushed by that experience, not so much because my candidate lost but because it seemed to me impossible to understand how so many could vote against their own best interests. I felt completely out-of-touch and no longer a citizen of a country I recognized. I wanted to move to Canada but Torie wouldn't let me. I decided I had to do something to change America back into a place I recognized. I began formulating a crazy dream about the grown up AMSA and suddenly California started to look welcoming again.
The antidote to despair is action.
Twelve short months ago, at the last AMSA meeting, on the occasion of Paul Wright's retirement, I challenged the many gathered AMSA alumni to make real the dream we have hoped for, for so long: to build the professional home to continue the good work, values, and idealism laid down in our AMSA tenure. Now I was too busy to even think about despair.
The antidote to despair is action.
Today I give you the antidote. The National Physicians Alliance, a multi-specialty, multi-issue organization that will put health before business, patients before politics, profession above privilege.
MISSION STATEMENT
The National Physicians Alliance is founded to restore physicians' primary emphasis on the core values of our profession: service, integrity, and advocacy. The NPA offers a professional home for physicians seeking creative collaboration and mutual support. As a diverse physician community, we work to improve health and well being, and to ensure equitable, affordable, high quality health care for all people
For the past year, a hardy group of 60 physicians from around the country have been working to create a movement that will change the culture of medicine and return our profession to one of service and advocacy.
The NPA's mission is broad: to seek high quality health care for all people, including comprehensive mental health services and end-of-life care; to fight for preventive health measures such as environmental clean-up and reduction of gun violence; to address the relationships between poor health, poverty, and race; to rid medical education of industry propaganda; to mentor student physicians in advocacy work; and everywhere to offer a strong voice in debates of public health and health-care policy-in the media, in academic journals, in medical schools, in local and state government, and on Capitol Hill.
The NPA is different. We are founded with the guiding principle to always, always place out patients' best interests above our own. We recognize that this will often be a serious challenge. To serve or patients, our practices must survive. To survive, we must bill. To bill, we must embroil ourselves in the dirty business of payment and reimbursement. However, to focus as an organization on these issues, to the exclusion of all other pressing issues in healthcare is folly. If we lose the trust of our patients we can no longer serve. That covenant, that sacred trust, is the fundamental basis of everything we do. Many, many medical organization have spent literally billions of dollars on issues related to physician payment. They know a lot, they do it well, I am grateful for their work on my behalf. I think, however, it is time for a multi-specialty, multi-issue group that focuses on health. One that will use the power, status, finances and access society grants us as physicians to fulfill the promise we make to our patients. To think always of their needs before our own. Without their trust we have no profession, we have no covenant.
The NPA seeks to restore a sense of professionalism and integrity to our profession. To this end we will accept no pharmaceutical monies. We acknowledge that much good comes from these industries. Many patients depend on free samples, and medical education and research have been driven forward light years by this industry. However this cannot justify the abuses, coercion, and profiteering that our profession willingly participates in by accepting to the point of almost complete dependence these monies. Our objectivity is lost. Our motives justifiably called to question. We must extract ourselves from these relationships. We must choose the right drug, do the right procedure with the proper instruments and in the proper setting because it is what is best for our patients--not because we owe someone, we like someone, or because it is just plain fun to do, no matter the cost.
To keep the NPA true we have built into our bylaws a council or consumers. A non-physician advisory committee with the authority to call to question our policies. To demand re-evaluation and rethinking of our decisions and ideas as well as bring forward issues we may be overlooking.
We will not appeal to everyone. We will not be all things to all people. Idealism, hope, integrity, generosity, and public responsibility are in short supply these days. We are too new to have successful projects to point to yet. But one must start somewhere and we choose to start with these ideals and build from them. Adding substance will be the responsibility of every physician who joins us. It will not be a question of what will the NPA do for you but more a question of what will you do to help the NPA make real the dream. It is the advantage and the challenge of beginning anything. We have spent a year trying to lay the groundwork to make that happen. Where it goes from here is completely up to physicians like all of you.
The next two days will be about learning from each other and your participation in the planning of how we move forward from here. This cannot be a movement of 60 physicians. To be successful we need people, time, and money. This next year will involve building membership, adding substances to our program areas, and building collaborative relationships with groups that share our heart and values-groups like AMSA, CIR, PNHP, PSR, and others. We need to synergize. To succeed in this political climate, to truly bring some form of basic health care to all of our people we will all have to work together.
We need a uniter, not a divider. We must stop re-arranging the deck chairs on the Titanic. There are a lot of smart people out there. There are viable solutions, and grand social experiments going on in pockets all over the country and the world. The NPA does not want to re-invent the wheel. We want to seek out the brightest and the best of these ideas. We want to build a coalition with organizations and individuals. We want to help highlight and actualize these ideas to the betterment of us all.
This will be all of our project together. I believe the need is there, the political climate ready, and the country yearning for leadership from physicians they truly believe are on their side.
Thank you.