Over the past two years, I have met the leaders of a relatively new physicians’ organization, the National Physicians’ Alliance, and I have been impressed by their agenda. Quite simply, they put patients first.  Here is their mission statement:

“United across medical specialties, the National Physicians Alliance was founded in 2005 to restore physicians' primary emphasis on the core values of the profession: service, integrity, and advocacy.  The NPA works to improve health and well being, and to ensure equitable, affordable, high quality health care for all people. The NPA strictly refuses financial entanglements with the pharmaceutical and biomedical industries.  To learn more, visit this site.

I would describe the NPA as “the new AMA.”  The NPA has been growing quickly, and it is stepping up to make its voice heard. 

At the end of March, when the Association of American Physicians and Surgeons (AAPS) announced that it was going to sue to try to overturn health care reform on constitutional grounds, I asked Valerie Arkoosh, president of the NPA,  if the organization  would like to comment.

First, the March 29 announcement of the lawsuit from the PR Newswire :

“The Association of American Physicians and Surgeons (AAPS) [has become] the first medical society to sue to overturn the newly enacted health care bill, the Patient Protection and Affordable Care Act (PPACA). AAPS sued Friday in the U.S. District Court for the District of Columbia (AAPS v. Sebelius et al.).

"’If the PPACA goes unchallenged, then it spells the end of freedom in medicine as we know it,’ observed Jane Orient, M.D., the Executive Director of AAPS. ‘Courts should not allow this massive intrusion into the practice of medicine and the rights of patients.’

“’There will be a dire shortage of physicians if the PPACA becomes effective and is not overturned by the courts.’

“The PPACA requires most Americans to buy government-approved insurance starting in 2014, or face stiff penalties. Insurance company executives will be enriched by this requirement, but it violates the Fifth Amendment protection against the government forcing one person to pay cash to another. AAPS is the first to assert this important constitutional claim.

“The PPACA also violates the Tenth Amendment, the Commerce Clause, and the provisions authorizing taxation. The Taxing and Spending power cannot be invoked, as the premiums go to private insurance companies. The traditional sovereignty of the States over the practice of medicine is destroyed by the PPACA.”

The National Physicians Alliance Replies:

When the Association of American Physicians and Surgeons (AAPS) filed a lawsuit against the Patient Protection and Affordable Care Act, the organization’s Executive Director, Dr. Jane Orient, described the recently signed health reform legislation as “the end of freedom in medicine as we know it.”  It is a bold, but ultimately wrong, statement of the history of American health care.  Because in our broken system, the last thing patients ever experience is freedom.

For how can there be freedom in a health care system that segregates patients by wealth, health and whether or not an employer offers health insurance?  Families have lost their fortunes under the current system, as reported last year in The American Journal of Medicine:  62% of the personal bankruptcies filed in 2007 were due to out-of-pocket medical expenses. On average, those expenses for families with private insurance equaled $17,749. For uninsured families, medical bills averaged $26,971. Others, because of pre-existing medical conditions, are trapped in unfulfilling jobs because that job offers health insurance and the next job might not.

More unjust than the loss of families’ economic security is the loss of life under the status quo. 45,000 uninsured Americans die every year. Those deaths are not from a misstep in biology or a failure of medical science. Those 45,000 Americans die from missteps in health policy –including a lack of investment in public health–and failures of insurance companies.  Where’s the freedom in all of this?

The injustices that accompany lack of health insurance fall particularly hard on minority communities.  Twenty-one percent of African Americans and 33% of Latinos are uninsured, significantly higher percentages than that of the general population.  Over 40 years ago, Dr. Martin Luther King Jr. said, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane."  The new health reform legislation takes bold steps towards rectifying this nightmare that has robbed Americans of their dignity, and yes, their freedom. Once fully enacted, the Patient Protection and Affordable Care Act (PPACA) will give 95% of Americans the basic human right to see a doctor when they need one. 

Interestingly, also over 40 years ago, the Association of American Physicians and Surgeons opposed another landmark piece of health policy:  the Social Security Act of 1965, which created Medicare and Medicaid. President Lyndon Johnson signed the law on July 30, 1965, and established a historic cornerstone of health care for seniors. The very next day, the Board of Directors of the AAPS stated “the effect of the law is evil and participation in carrying out its provisions is, in our opinion, immoral.”  The following week, on August 4, the AAPS urged its members to boycott Medicare.

So when Dr. Jane Orient describes the current legislation as “the end of freedom in medicine as we know it,” perhaps she is speaking from her organization’s longstanding tradition of opposing health care as a basic human right.  Though her opinions might have been well received by many physicians in the 1960’s, today she and the AAPS are alone. During the struggle for health reform, 14 national medical organizations representing 500,000 doctors, including the National Physicians Alliance, came together to express their support for health reform.

Like many of those half a million doctors, the 20,000 members of the National Physicians Alliance have born witness to the inequities and inadequacies suffered by our patients and their families in the old broken system of American health care. We have given those patients and families a voice in the health reform struggle, and we applaud the passage of the Patient Protection and Affordable Care Act. We are glad to roll up our sleeves and pitch in to build better ways of caring for patients under this act. From the perspective of the National Physicians Alliance, the new health reform legislation is the first step toward ending the injustice in medicine as we know it.

Sanjeev Sriram, MD, MPH,

 Director of Membership Communications and Outreach

Valerie Arkoosh, MD, MPH
President

National Physicians Alliance

My comment: In 1965 the AAPS called Medicare and Medicaid “evil.” Now they say that health care reform marks “the end of freedom in medicine as we know it.”  It seems that over the course of 45 years, the organization has not learned that hyperbole is rarely persuasive.

It also appears that the leaders of the organization have not read the reform bill carefully. AAPS claims that the penalties for not buying insurance are “stiff.”  Seventy-five dollars a year is “stiff”? See my post on “Myths and Facts about Health Care Reform” below.

AAPS also frets that as we extend coverage we will face a shortage of physicians. What is the alternative—to leave 30 million Americans uninsured?

I agree that we will need more primary care physicians, nurse practitioners, public health workers, psychologists and physical therapists. The legislation addresses these needs by providing new funding for med students who go into primary care, for doctors already practicing primary care, and for nursing school teachers. 

It is not at all clear that we will need more specialists in many areas—including surgery. We already perform more surgeries than any other country in the world, and as Boston surgeon Atul Gawande points out, there is no evidence of better health or better outcomes as a result.