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AMA's aim is care for everyone

Although her official term as chair of the American Medical Association's Board of Trustees doesn't start until next year, Dr. Ardis Hoven already is helping shape health care reform.

In an interview with the Herald-Leader, Hoven, an infectious disease and internal medicine expert at the University of Kentucky who is also director of the Bluegrass Care Clinic, said reform is needed, a significant plan is likely to emerge but there is plenty of work to do. Hoven, who has long been active with the iconic physicians group, said the need for reform shouldn't be overshadowed by the ever-increasing rhetoric.

"There has been some very mean-spirited stuff going on and I think for the American people that makes them uncomfortable. It makes me uncomfortable," she said. "We've somehow got to get past the politics of it and get on with doing what really needs to be done."

Question: What are some of the key points you are focusing on as you talk to people about this reform?

Answer: One of the things that we have been working on for a long time is covering the uninsured. The issue of universal access is something we feel is extremely important. That probably is one of the cornerstone issues — the cornerstone issue — of health system reform from the AMA perspective.

When you've now got 48 million uninsured, we are not talking about those who are Medicare or Medicaid eligible. We are talking about adults, 80 percent of them have jobs but they can't afford their health insurance. We are looking for the mechanism whereby these individuals can, a.) afford to buy health insurance either through their employer or, b.) be given tax credits so they can go out and buy their own insurance.

Q: Why do the words "universal health care" send shivers down so many spines?

A: So many people equate that language with systems that are seen in other parts of the world, in the United Kingdom, the Canadian system and that sort of thing. What we want to do is get as many people covered as possible. And the best language for that is "universal."

Q: How would the American version differ from those in other parts of the world?

A: One of the premises the president has made very clear is let's build on the system of health care in this country, parts of which we know work very well. Let's fix the stuff that isn't working well. Let's make the correction. And in this country, freedom of choice is a very important thing to all of us. Being able to have a choice to pick the doctor you want, to pick the health insurance you want, to pick the hospital where you get care are all important to the American people, thus we would encourage that we build on a system that provides good care but make improvements.

Q: What part of the system works well?

We have technology, we have science, we have, believe it or not, access to quality health care in this country that is not the same in other parts of the world. What we need to improve on, however, are making sure that those individuals who are uninsured, that they get care when they need it. They are just not getting the preventative care that they need. We know how to do it. We do it well, we just need to make sure these folks get into the health care system so they can get the preventative care that they need.

The important piece is the relationship between the physician and the patient.

Q: One of the common complaints about the system is that physicians have been stretched so much that it is getting harder to create relationships with them.

A: Right now a physician's office is burdened by an excessive amount of administrative stuff that we have to handle, the bureaucracy, the astronomical paperwork that we have to do. If you are talked about being taxed or stretched that's where the problem is. What we need to do is administratively simplify what goes on in my office. Free up some of that time to deliver care to the patient.

Q: There is so much rhetoric being thrown around about health care reform, it's hard for individuals to get a feel for what it is going to mean to them.

A: There is so much activity right now. You are correct. You've got the House and its committees doing their work, you've got the Senate and its two committees — I think it's the health and the finance committees — doing their work. It has become very political. But this should not be a Democrat or Republican issue. It should be about the patient.

Now having said that ...that's my ideal perfect world. It is a very political situation. We have got to be very careful that we don't allow the politics and the controversy to overshadow the significant progress that has already been achieved.

Q: Talk about the progress.

A: I am going to talk about that from the AMA's perspective. ... The president came to speak to the AMA in June. He made a very significant health policy speech to the delegates. What he made very clear to us was he was going to build on what works, which is what we needed to hear, and it had to do with the uninsured and cost. Moving forward (from that) the AMA has been an active participant and been given very wonderful opportunities to be engaged with leadership of the committees, the senior staff of the committees working out of the House and the Senate and the White House itself.

To have a seat at the table is extremely important to be able to get the work done.

For example, the House Energy and Commerce committee ... passed some very important AMA-supported revisions to the House bill that would allow physicians to negotiate payment rates. (That will attract more physicians to the program.)

There is a lot of discussion going on and their bill expands coverage to a choice of plans. It addresses denial due to pre-existing conditions, which is a very important issue, and it repeals the flawed Medicaid physician payment formula. There are a lot of things that are AMA-driven that are showing progress at this point.

Q: Which issues are especially relevant for Kentucky?

A: The number of uninsured that we actually have in the state of Kentucky, and I saw anywhere from a half a million to 1.2 million, ... we have a significant number of uninsured in this state that need to have access to health insurance. That's a big issue here. Something the AMA talks a lot about is quality of care. Every doctor wants to provide the best quality of care possible and that includes patients in Kentucky. We have to be sure that physicians have the tools to be able to do this. One of the tools has got to do with information technology and making sure that our doctors have access to real-time information, point-of-care information, that enables them to do the kind of work that they want to do. And, technologically, this is very expensive. While group practices and big hospital systems can afford to do this, smaller practices or one- or two-person practices — particularly what you see in rural parts of Kentucky — are not going to be able to afford this. They are going to have some sort of help or assistance to get this accomplished.

Looking at the whole health system reform debate, IT is going to be part of the debate. This is going to be very important for the doctors and ultimately the patients in Kentucky.

The other portion that not only applies to Kentucky but also every other state is the issue of cost containment. That word is a bad word. It really should be "appropriate cost" because what we want to do is see the spending curve get bent a little bit downward so the costs don't keep escalating.

And that will require physicians and practices to be able to share information. They need to engage in group activities, as you will, that are centered around quality and cost and how to efficiently deliver care. Right now we don't have the ability to do that because of the antitrust stuff hanging over us all the times.

Q: What are three things people need to know be aware of?

A: If you like your doctor and you like your insurance you are going to be able to keep it. Two, we are not talking in this country about a single-payer system. No one is talking about a single payer system in this country. We are not going to have total control of health care by government. And, thirdly, and most important, for people out there who don't have health coverage and health insurance, they are going to get it.

Q: You make it sound so simple.

A: Well, in my head it is. I am not a lawyer. I am not a legislator, but I do get to dream the big dreams. If people will remember that these are the drivers. ... This is what this needs to be about, the patients getting the care that they need and creating the system that allows them to get it.

Q: What are the chances that there will be significant legislation passed this year?

A: I think they are good. When will they happen? I don't know. I think the president's time line isn't going to be met, and in some ways I think that is good. In some ways I think you do slow the process down a little bit so we don't create something that has unintended consequences. On the other hand you don't want to slow it down too long because then nothing will happen.