What do "Gulliver's Travels," George Orwell's "Animal Farm," and "Mr. Smith Goes to Washington" all have in common? No, they are not today's Gold Box deals on Amazon. They are all used to illustrate the failings of the Affordable Care Act by a former president of the American Medical Association.
In a new editorial for the Journal of the Louisiana State Medical Society, Donald J. Palmisano, MD, the AMA's president from 2002-2004, renews his objection to the federal health reform law voiced during the legislation's creation last year. And he doesn't pull any punches, informing readers that the Affordable Care Act, "will be a disaster."
Palmisano highlights the "rushed" process to pass the bill by Congress, renewing the "Did they even read it before passing it?" debate and reminding readers that legislation is the foundation for pages upon pages of new regulations that will tie down U.S. physicians. Enter the Gulliver analogy as the giant is bound to the ground by the Lilliputians.
The former AMA president recounts how the harder Gulliver fought, the more his little captors assaulted him, extolling, "We must not let this happen to medicine!"
He also goes all literary on us in reminding that "Having an insurance card is no guarantee that you can find a doctor willing to take payment below the cost of delivering care," via Medicaid expansion and that while Congress gets to choose from private market healthcare options, the same method will not work for the masses.
Palmisano notes, "the approach of Congress is reminiscent of ….'Animal Farm,' where 'All animals are equal, but some animals are more equal than others.'"
The good doctor also takes us down memory lane to 2009, repeating his objection, as well as other former-AMA presidents, to various sections of the bill and how they would have focused on issues such as tort reform and selling health insurance across state lines.
"The AMA made a serious mistake supporting this bill," he adds, echoing the sentiment of a lot of physicians these days.
Palmisano even ties in the pending Medicare reimbursement cuts coming in December unless Congress acts. He calls the sustainable growth rate (SGR) formula "an abysmal failure," touting free enterprise instead as way to cure physician payments. [Keeping with the analogies, he notes that "that is why the Kindle e-reader dropped significantly …when the Barnes & Noble Nook and Apple iPad came out."]
He concludes that — with the November mid-term elections nearly upon us — that Americans, both those with medical training and those without, need to "replace those in Congress" and instead "we need more individuals akin to 'Mr. Smith Goes to Washington.'"
I applaud Palmisano's call to action for all of us — physicians and non-physicians alike — to get involved in what's going on in Washington, D.C. I have no doubt the mid-term elections will be as much about healthcare reform as they are about jobs and the economy.
But perhaps real-life examples of the impact of health reform are the best defense against the bill, not using giants, talking animals, and Hollywood heroes. When it comes to separating reality from myth, the healthcare debate seems to skew towards the latter, drawing incomplete comparisons at best.
Doctors, like Palmisano, need to make their patients, fellow colleagues, and especially those in the nation's capital aware of the real impact of legislation, not what could be, what might be, or what the future possibly could bring thanks to the Affordable Care Act.
Let's leave the imagining to authors and movie producers and put the facts out there to truly show how legislation becomes a part of everyday life.