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The Need for a Clear Message of Opposition 

After reading the article in the March Ophthalmology Management entitled “Are Medical Societies and MDs Out of Sync?” in which the Academy’s medical director of Health Policy is quoted, I feel compelled to respond. Dr. William L. Rich states, “I supported the [health care reform] bill because I thought it was best for the patients and, frankly, it’s best for our docs. We did okay.”

Abdicating our primacy as physicians and surgeons to a bureaucrat-run system of rubrics and rationing is not best for physicians, patients or America. I have read and critiqued 55 pages of the bill as part of the Physicians’ Council for Responsible Reform (PCRR) founded by Rep. Tom Price, MD (R–Ga). This bill is the disjointed disassembly of the private sector practice of medicine. It further escalates deficit spending and unfunded mandates, and opens the door to draconian rationing. It reduces physicians to widgets in the system as data gatherers and standardized health care dispensers à la Donald Berwick’s central planning schemes. Many sections are fiscally and logistically unachievable. If you’re interested, you can find my critique and a suggested template for sustainable reform at www.usaHealthalert.org.

As for the impact of such statements and medical organizations supporting the bill, I can only quote what the Speaker John Boehner (R–Ohio) said to our group of about 90 physicians in Washington, D.C., at the last PCRR board meeting: “If the AMA had come out against it, it would not have passed.” That is a heartbreaking statement made more so by the fact that the AMA represents no more than 15 percent of private practice physicians.

In discussing what I had inferred as the Academy position on the bill with a senior Academy leader, I was gratified to learn that Dr. Rich’s quote was taken out of context and did not reflect his tireless actions on behalf of practicing physicians and our patients. However, it illustrates that we do not have a clearly articulated message of opposition to this bill, a message that is understood not only by the membership, but by the public and by elected officials as well.

Our system needs reform, not the federal takeover of one-sixth of the private sector economy using medicine as the vehicle. The first step for reform is the repeal of this malicious piece of legislation passed by methods that are an affront to every citizen regardless of political affiliation. Currently, there are members of Congress in leadership positions working for every opportunity to strip funding from many parts of the bill until the next opportunity for repeal. The constitutionality of the bill awaits the Supreme Court decision, and many states are taking steps to resist the federal takeover of the health care system.

I urge the Academy to formulate a clear message of opposition based on the principles of a doctor-patient centered system. We can have a huge impact with principled and forceful opposition. The timing couldn’t be more urgent.

Jane Lindell Hughes, MD   
San Antonio, Texas   


WRITE TO US Send your letters of 150 words or fewer to us at EyeNet Magazine, AAO, 655 Beach Street, San Francisco, CA 94109; e-mail eyenet@aao.org ; or fax 415-561-8575. (EyeNet Magazine reserves the right to edit letters.)


EyeNet invited Dr. Rich to reply to Dr. Hughes’ letter. 

Thank you for the opportunity to respond to the thoughtful letter written by Dr. Hughes regarding my quote in the Ophthalmology Management article “Are Medical Societies and MDs Out of Sync?”

My statement reflected a personal observation on the totality of the bill and didn’t reflect extensive discussions of the pros and cons of the Patient Protection and Affordable Care Act. Neither the Academy nor I personally supported the health care reform bill in its final form. Working with a coalition of other surgical specialties, the Academy still has significant concerns about many aspects of this far-reaching piece of legislation. The good: coverage of most of the uninsured, removal of preexisting conditions as a barrier to commercial health insurance coverage, the elimination of lifetime and yearly caps on medical expenditures, the ability to keep young adult–dependents on a parent’s plan until age 26, and maintenance of a pluralistic health care delivery system. There are, however, many aspects of the bill that are onerous and will have to be addressed in the years to come.

I couldn’t agree more with Dr. Hughes about the need for medicine to strongly articulate the core values that are important to us all. While we can’t ignore the need for some changes in the U.S. health care system, we must forcefully defend the importance of the physician-patient relationship as critical to the care process.

The Academy will continue to advocate these principles for our patients and members as the bill undergoes ongoing refinement in the years ahead.

William L. Rich III, MD   
Falls Church, Va.   


Interested in Advocacy?

For the latest advocacy news, as well as a wide range of advocacy resources, go to www.aao.org/advocacy.

Visit the Action Center for tips on federal advocacy, as well as action alerts—which provide an easy way to contact your legislators about urgent issues—and links to state societies. Other web pages are devoted to:

  • Medicare
  • sustainable growth rate
  • PQRS
  • scope of practice
  • Surgery by Surgeons
  • state legislative tracking
  • Surgical Scope Fund
  • OphthPAC


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