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- Anthony N. DeMaria, MD, MACC, Editor-in-Chief, Journal of the American College of Cardiology⁎ ()
- ↵⁎Address correspondence to:
Dr. Anthony N. DeMaria, Editor-in-Chief, Journal of the American College of Cardiology, 3655 Nobel Drive, Suite 630, San Diego, California 92112
Except for the comatose, everyone in the world is well aware of the historic inauguration of Barack Obama as the 44th President of the U.S. A classic example of American diversity, he is the son of a black man from Kenya and a white woman from Kansas who was born in Hawaii, educated in the Northeast, and settled in the Midwest. Blessed with an outstanding intellect, even temper, and articulate tongue, he overcame any racial bias that he encountered. His election both brought honor to Obama and enhanced the country's image of itself.
Part of the enthusiasm for President Obama's victory is likely due to the problems besetting the country (and the world) and the hope that a new direction could overcome these difficulties. Of particular concern is the dire economic condition afflicting the country. As has been abundantly documented in the lay press and media, we are experiencing the worst economic conditions since the Great Depression of the 1930s. Triggered by the fall in real estate values, both foreclosures and bankruptcies are commonplace and the gross domestic product, corporate profits, and stock prices have declined. The unemployment rate is edging up toward 10%, and nearly everyone has a relative or friend who is out of work. Numerous data document a prevailing sense of financial insecurity and a movement toward financial austerity. These are certainly the most trying economic times I have experienced, and it appears certain that, at least temporarily, we are facing a diminished standard of living.
President Obama has promised a less divisive and less self-interested form of government. In dealing with the economic crisis, he has called for sacrifice and for a banding together for common purpose. He has appealed to our highest instincts as a society and to a spirit of sharing the pain. In his inaugural address, the President extolled the virtue of those who showed “kindness to take in a stranger when the levees break” and the “selflessness of workers who would rather cut their hours than see a friend lose their job” (1).
We in medicine are not immune from these economic tensions. Even before the current crisis we were often taken to task for a health care system with over 30 million uninsured at a cost of over 10% of the gross domestic product. Our ability to appropriately utilize technology and practice cost-effective medicine was questioned. Issues such as the sometimes substantial geographic variation in the utilization and cost of medical procedures were frequently raised. While acknowledging the seriousness of these problems and making efforts to deal with them, we have reacted to staunchly defend the quality of the care we provide and vigorously justified the value we bring to the health care system to an even greater extent.
The current economic crisis has brought issues regarding the delivery of health care into even sharper focus. During the campaign, President Obama promised to make “reform” of the health care system one of his highest priorities. He indicated that he is committed to addressing the problem of the uninsured, and to managing costs and maximizing efficiency. Given the downturn in the economy, the number of uninsured will certainly increase, and the need to redirect funds to other segments of the economy will intensify. As physicians, we will face increasing pressure to hold down costs, accept reduced reimbursement, and provide even more uncompensated care.
It seems to me that there are several ways in which we could respond to the increasing demands upon the medical profession. The initial tendency might be defensive. We may view any attempt at cost containment or reduced reimbursements as an attack. Certainly, one would be hard pressed to identify a profession that worked harder, and for larger stakes, underwent greater self-examination, or delivered a more valuable service to society. We might feel justified in digging in our heels and resisting any change to our compensation. However, I believe this would be a mistake.
In considering our response as physicians to the economic crisis, it seems to me that we should follow the spirit advocated by President Obama. These are hard times, and the pain is pervasive throughout society. It would be a terrific contribution if physicians were selfless and led the way by doing something to benefit others. There are certainly many ways to do this. I have thought of conducting an extra clinic just to see cardiac patients who have recently lost their jobs and health insurance at no cost. Just the act of gracefully accepting a small decrease or foregoing an increase in reimbursement for the common good, at least until the economy has recovered, would be a valuable action. At the very least, it would reflect very well on the medical profession and probably make us feel better about ourselves.
The election of President Obama represents a turning point in many ways. He is intent upon bringing a renewed sense of cooperation and selflessness to our society. Such behavior could not occur at a more appropriate time than the present, during which we face such major financial challenges. We are all being asked to make sacrifices for the common good, and few have as strong a tradition in this regard as physicians, who have sacrificed much to get where they are. At this point in time, rather than retreating to bunkers, we should be open to doing our part to share the pain. It would be a magnanimous gesture to take the lead in seeing what we could contribute to resolve this economic crisis. Who knows, it might set an example that others would follow.
- American College of Cardiology Foundation