Politics can be bad for your health — literally. As a doctor, I feel that patients' needs must trump political party. But instead of benefiting from bipartisanship, health care has become highly politicized. Traditional party positions are being contradicted by belligerence that threatens patient care.
That is not to say that the Patient Protection and Affordable Care Act is perfect. But this law represents the first successful reform of health care in more than four decades. Now, in their worry over bogus issues such as big government and unconstitutionality, many Republicans and Democrats alike have overlooked the real values in the law: things like increased coverage, cost controls and flexibility for doctors (not government) to help make these reforms succeed.
One thing is sure: If Congress votes to repeal the law — or withholds funding when President Barack Obama vetoes the repeal — it would not only be immoral; the effect of such craven negativity would be to leave Republicans wide open for a rout in 2012, given the country's increasing health care distress. The October AP-GfK Poll shows that a majority of Americans now want the law left as is or made stronger.
Democrats are partly guilty because they compromised so much that the insurance companies instead of the physicians have retained control over patient care. Many Democratic candidates have been reticent to proudly proclaim the new law's advantages.
Despite the poisonous pre-election rhetoric surrounding the health care law, bipartisanship on this issue is still possible. After all, ordinary Americans of all parties recognize the disastrous health care situation America faces and the need for reform. And most doctors, whether Republicans or Democrats, would like to transfer medical decision-making from the insurance companies and the government to physicians.
Bipartisanship, after all, is part of America's history. In their goal to "form a more perfect union," the Founding Fathers recognized the uproarious divisions among the colonies. Our strength now is largely due to the sprit of compromise with which those early states united.
Today, appropriate federal support for health care must be recognized by both parties as a cost of doing business for our country. The 2009 GOP platform on health care proposes: insurability regardless of pre-existing conditions, prevention of unjust policy cancellations and maintaining dependents longer on their parents' policies. All of these Republican measures are in our new law. And the formal role that I propose for doctors — a novel idea not yet tainted by party dogmas — can provide an additional basis for restoring bipartisanship to support a spare, effective federal health care system.
If a new day of bipartisanship were to dawn, what might both parties contribute to a constructive vision for the nation's health?
It is said that we cannot have all three of the basics for health care reform: high quality, cost control and access for everyone. But that is not so. If we improve quality, it will save money, and we can extend health care to everyone with the savings.
Quality is based on clinical criteria. We can have high-quality care if doctors are given a formal national responsibility for it. The new law allows doctors to do this, and it will work. The U.S. organ transplant system has been run successfully for two decades by medical authorities, under a federal law. That model can be extended to our entire health care system. This will only happen with bipartisan support.
Take accountable care organizations (ACOs), which allow medical professionals to organize efficient quality care. Testing, consultation and follow-through on recommendations are streamlined. Mistakes and malpractice vulnerability are minimized by ACOs. They can save money.
Cost savings will also come from stopping the dispensing of unneeded "care" even if private insurance or Medicare will pay for it. Since all procedures carry risks, such overutilization is not only expensive but dangerous. Additional savings will come from the control of illegitimate insurance denials, which are dangerous for patients and waste expensive time for both the insurance companies and the doctors who fight them.
Previously, Congress tried to control costs by a law that restricted increases in doctor-controlled Medicare spending. But in recent years Congress has forbidden Medicare to make the necessary cuts, and now this "sustainable growth rate" law would dictate a 30 percent cut in that Medicare reimbursement this January. This would make it impossible for many doctors' offices to see Medicare patients. Decisions made by doctors in charge of care based on clinical criteria can save that money without hurting patients.
All of these are improvement opportunities that would best be achieved by doctors with the qualifications to judge the clinical details. The flexibility in the new law allows for professional expertise to provide quality improvement with authoritative national guidelines that doctors will follow.
Who was the president when the public-private national transplant system that is a model for physician involvement was passed? Ronald Reagan. Regardless of the party in control, putting patients first will serve everybody's constituents. Based on that common interest in what's best for patients, dare we hope for a new bipartisanship?
Dr. James Burdick, a professor of surgery at Johns Hopkins University School of Medicine, served in the Department of Health and Human Services as director of the Division of Transplantation. He is writing a book detailing his doctors' plan for health reform. His e-mail is jburdic1@jhmi.edu.