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YO Perspective: Why I’m Hopeful About the Future of Health Care
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Arriving at Union Station in Washington, D.C., on the evening of April 6 for the welcome dinner of the Academy’s Mid-Year Forum, one could be excused for feeling pessimistic. The whole city anticipated a government shutdown by the end of the week, as Republicans and Democrats plodded through marathon negotiating sessions, seeking to cut billions from the federal budget and taking partisan swipes at each other in newspapers and on news websites.

With the mood on Capitol Hill so apprehensive, it did not seem like an auspicious time to begin a lobbying effort arguing against reduced payments to physicians. However, it’s hard to keep a hopeful, young ophthalmologist down, so off I went to begin my first experience on Capitol Hill with a sense of cautious optimism.

While this optimism might seem naïve, I do realize that politicians have not been a source of encouragement for ophthalmologists in recent years. Lately, physician reimbursement under Medicare has been a ripe target for members of Congress seeking savings in federal spending.

The 2010 Patient Protection and Affordable Care Act made sweeping changes to the American health care sector, yet failed to include even one physician on its Independent Payment Advisory Board (IPAB) – and pointedly excluded meaningful medical malpractice reform. At the state level, several legislatures have acquiesced to the encroachment of optometric practice in areas once reserved for surgically trained, board-certified medical doctors.

Despite these distressing facts, I hoped for the best during Congressional Advocacy Day. I, along with other Virginia ophthalmologists and ophthalmology residents, met with the staff of our two senators, Jim Webb, D-Va., and Mark Warner, D-Va., as well as one Congressman, Rep. Jim Moran, D-Va. We discussed the political issues most affecting physicians in general and ophthalmologists in particular.

Even though politicians have left physicians much to desire over the past few years, I nevertheless felt inspired while walking those hallowed halls, past Harry Truman’s and Lyndon Johnson’s old Senate offices, and toward beautiful marbled conference rooms. I was star-struck when Sen. Warner came by to shake our hands.

We may not know how much impact we had when we urged those with whom we met to require physician representation on the IPAB, and to support the Truth and Transparency Act (which would require all health care practitioners to be open about their credentials and level of training), but we made a strong effort and expressed our positions enthusiastically.

I am optimistic about the future of American health care because, at the end of the day, despite all the doom-and-gloom conjecture, there was no government shutdown. And, if compromise on America’s spending can be found in such a partisan time in our history, there is hope to be had.

Despite the fact that health care-related issues do generate ferocious debate, there appears to be bipartisan agreement that improving the climate for physicians is an important goal. For example, H.R. 452, a bill to repeal the IPAB as part of the Affordable Care Act, was introduced by Rep. Phil Roe, MD, R-Tenn., an obstetrician-gynecologist, and enjoys strong Republican support as well as bipartisan support from its three Democratic co-sponsors: Reps. Michael Capuano, D-Mass., Shelly Berkely, D-Nev., and Larry Kissel, D-N.C. The bill has been referred to the House Subcommittee on Health for hearings and markup.

So yes, young ophthalmologists, I do believe that there is hope that our burgeoning careers will not yet be hobbled by political machinations. But, we should understand that our future can only bear out that optimism if we control our own destinies by getting involved.

While it may be tempting to focus on clinical care and research to the exclusion of all else, we all have an obligation to petition the government for redress of our grievances and to educate our legislators at the state and federal levels on these issues. Only if we engage in this type of grassroots lobbying, will our optimism be justified.

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LichtensteinAbout the author: Erin Lichtenstein, MD, is in her final year of an ophthalmology residency at the University of Virginia. She was sponsored to attend the Mid-Year Forum by the Virginia Society of Eye Physicians and Surgeons. Originally from Haddonfield, N.J., Erin completed medical school at Georgetown, followed by an internship at Harbor Hospital in Baltimore. This summer, she, her husband and their one-year-old son Benjamin will be moving to Mobile, Ala., where she will join a private practice.

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