Winning The Health Care Battle For All Of Us.(Randolph D. Smoak, President of the American Medical Association)(Transcript)

THE FEDERAL PATIENTS' BILL OF RIGHTS

A president-elect of the American Medical Association, I log a lot of miles on the road. And I can't tell you how nice it is to have a reason to come back home for a speaking engagement.

And to especially be asked to speak here before you today, in a place that holds a lot of symbolic importance to me.

Because I'm not only an adjunct member of the faculty of the Medical University of South Carolina -- believe it or not, my wife and I actually attended college right here on this campus. And two of my four daughters and one son-in-law got their MBAs here.

So the rich history of this university makes me a little nostalgic. And if it's possible, this building makes me feel even more so. Standing here in Strom Thurmond Auditorium takes me back -- believe it or not -- all the way back to World War II.

Because back then, when I was a little boy, I used to live next door to Strom Thurmond's aunt.

Growing up in Bamberg, I remember my father and a bunch of his buddies gathering every evening at the drug store -- listening to radio reports on the war.

The drama of those reports was impressive. But it was nothing next to the day that I actually met Mr. Strom Thurmond. He came back from the war as a hero, and he received a hero's welcome and a parade.

He had been there on D-Day at Normandy. And came home bearing no fewer than 18 separate decorations for his military service.

At my tender age, he was larger than life to me -- as he has been to all of us in this state ever since.

Because the year after he returned from the war, he was elected Governor of South Carolina. And the rest, as they say, is South Carolina history.

My early exposure to this man -- who is the namesake of this auditorium - had a profound affect on me. It eventually fueled my lifelong interest in politics.

So, standing here, I feel a little sense of history.

And that's what I'd like to do here today -- share a little bit of that sense of history on one of the most vital legal and ethical issue facing all of us today - but especially the nation's patients and their physicians.

The federal Patients' Bill of Rights legislation.

I'd like to do this by explaining a little bit of the history of how the American Medical Association became involved in this issue and where we see this issue going as we quickly approach a new millennium.

I know that most of you here today are training now to become advocates. Well, the AMA also is in the advocacy business. Just as you will soon advocate for the interests of your clients, the AMA advocates every day for our "clients" -- the nation's patients and their physicians.

And that's become even more important, as over the past few decades, we've witnessed a tremendous shift in the health care marketplace.

There was a time, not so very long ago -- even when I was growing up not too far from here -- when, lit rally from cradle to grave, patients had one physician who cared for them and for their entire families. My family doctor, Dr. Stuckey, delivered me and cared for my family for years. Unfortunately, this is the exception, not the rule, today.

Instead, the rising cost of care through the 1970s and 1980s saw the delivery of a new kind of health care -- managed care, where our ancient patient-physician relationships are driven not by family ties but by economic imperatives.

Managed care has its positives. It has done a great deal to bring efficiency to the system. By keeping track of how much care is given -- through patterns of evaluation that show whether a given treatment is warranted and effective. And by eliminating redundancies and inefficiencies in the system. For instance, making sure that expensive specialty care is necessary.

So, as managed care emerged and took hold -- as capitation began to replace fee-for-service ... as gatekeepers began to hold the line on unnecessary specialty care ... as patients began to move into the plans in greater and greater numbers ... an economy of scale and of services was born. And for a while, that did slow the rise in health care costs.

Using these strategies and others like them, managed care has eliminated much of the excess spending in the American health care system.

But now, we're past that first blush of success and we're beginning to see dissatisfaction growing.

In fact, today, patients and physicians alike are dissatisfied with the changes they've seen in health care delivery in recent years.

As patients are shuffled from plan to plan at each open enrollment period -- like so many items at the supermarket checkout counter.

As patient-physician relationships are severed, as doctors are deselected by plans, based not on quality, but on economics.

And as physicians have found our autonomy eroded - with each new procedure that requires approval from some health plan bureaucrat miles away. Who, without benefit of medical training or experience, decides what care is best for our patients.

These issues have concerned patients and physicians in the private sector for some time now. But today, there is a new concern and it threatens to create more change, and soon.

Because now, costs have started to rise again.

And as a result, employers -- those who pay for most health care in this country -- are now joining patients and physicians in the ranks of the dissatisfied.

You see, most employers right now are facing a rise of 7 percent or more in the cost of insuring their employees for the year ahead. On the West Coast, those numbers are as high as 19 to 21 percent.

While, at the same time, the ranks of the uninsured continue to rise -- those who are without access to the system at all.

You've heard the latest numbers -- 44 …