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I’m frequently asked, “What’s the Academy’s position on repealing the Affordable Care Act?” This is an extraordinarily complex issue—and the answer to the question must reflect the gravity and complexity of the issue. It is far from a simple “We’re for it” or “We’re against it.” Either of those statements must then lead to a plethora of related questions such as: What about preexisting conditions? What about Medicaid funding? What are the cost implications? What will be the impact on physicians? What will happen to safety net hospitals? Will some or many Americans lose health care coverage? And will it be affordable?
The Academy will have positions on many of these issues. These positions will be developed through a very comprehensive process encompassing a combination of broad-based member input (from hundreds of members who submitted their priorities in response to the Academy’s request), consultant and staff advice, and the direct input of nearly 100 members of groups such as the Ophthalmic Advocacy Leadership Group (with representatives from all major subspecialty and specialized interest groups in ophthalmology), the Academy Health Policy Committee, and others.
The process is guided and bound by a set of principles. Although they aren’t codified, they are ones that we—as citizens and physicians—intuitively understand: Balancing professional self-interest and national interest. Putting patients first. Ensuring economic integrity. Upholding a commitment to quality. Reducing clinically irrelevant regulations. Supporting the patient-physician relationship. Protecting patients’ access to care. And so on. Each policy option must be scrutinized through these lenses for fealty to the professional principles we hold important.
One principle must be reducing uncertainty for patients and physicians. We as physicians have lived and worked far too long dealing not only with continual change as a part of health care reform, but also coping with a system in which final rules may be issued only a few weeks before they become effective and in which apparent “solutions” lead to a host of serious real-world unintended consequences for patients and physicians alike.
As our profession approaches a new administration with new priorities and promises, the Academy must and will engage in the issues. We are very cognizant of the fact that among all the major professional organizations in ophthalmology, there are only 14 full-time staff based in Washington, D.C., to represent our interests—and 12 of them work for the Academy. The Academy is fortunate to have the active support of a handful of strong subspecialty organizations in these initiatives—but the boots on the ground are ours. Our profession is also ably represented by 3 D.C.-area ophthalmologists who dedicate large portions of their time to these issues—Mike Repka, Bill Rich, and David Glasser. And our Secretary for Federal Affairs, George Williams, spends many weeks every year in D.C. devoted to this task.
I recently saw a column in The Wall Street Journal entitled “So, You Got a Job at the White House…”1 The author, Karl Rove, provides advice for new White House Trump administration staff. It’s worth reading because it applies to more than just the White House. In it, he says:
“To cynics it might sound trite, but when you walk into 1600 Pennsylvania Avenue, your party affiliation matters less and your responsibility to your country counts even more. You become a small player in America’s unfolding, centuries-long drama. Then once you lose that special feeling, it’s time to go.
“Late in the evening on one of my first days in the White House, the janitor came by to handle his chores. As he left, he caught my eye and quietly said, ‘Honor this house.’ Pretty good advice.”
The same can be said for us all. As we deal with the unfolding events, let’s remember to “Honor this profession.”
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1 The Wall Street Journal. Jan. 12, 2017, page A15.