January 2001 • Volume 7 Number 1
Speak out for patients despite 'inscrutable' politics
BY CINDY McCANSE
"Health policy has always been political. It's now becoming bitterly partisan," says Emily Friedman.
Frustrating as it may be, no one should be surprised that the 106th Congress failed to pass the sort of sweeping patient's rights legislation backed by the AAFP and other medical organizations.
At least, that's the opinion of Emily Friedman, noted author and lecturer on health policy and social ethics.
"I find it astonishing that any health policy ever gets made," Friedman said in her keynote address at the Nov. 17-18 AAFP State Legislative Conference in New Orleans. "The reason is that this is really hard stuff."
Typically, she said, health policy is adopted in increments. She pointed to the establishment of Medicare and Medicaid during the 1960s as a notable exception, one not likely to be repeated any time soon. That accomplishment, Friedman noted, was due largely to the "talents" of former President Lyndon Johnson -- both his commitment to this social cause and the fact that "he had stuff on everybody in Congress."
A native of Los Angeles now based in Chicago, Friedman is no stranger to political maneuvering. She recalled the likes of Chicago's storied father/son mayoral duo, Richard J. and Richard M. Daley, and long-time Louisiana governor Huey Long, as she spoke about the intricacies of forging political alliances to accomplish legislative goals.
"It's important to remember that our priorities are not necessarily everyone else's priorities," she explained to 125 family physicians, health policy-makers, and chapter executives and lobbyists. "Health policy hasn't been a priority for Republicans; national defense hasn't been a priority for Democrats.
"Health policy has always been political," said Friedman, "but it's now becoming bitterly partisan."
Party members these days adopt the position of their party whether or not they actually understand the issues involved, she claimed. "A word to those of you who will be working with members of Congress: There are quite a few dim bulbs on both sides of the aisle."
Special interest lobbyists with deep pockets often guide the actions of legislators, said Friedman. And the introduction of state term limits has further complicated matters, she added. "When there's no consistency, when there's no continuity -- lobbyists make the policy."
Even so, it's essential for health care providers to take every chance to speak out in the best interests of their patients, said Friedman. "Front-line health care professionals know more than anybody else about how health policy affects patients. Use that credibility. Use your influence to increase the amount and quality of civil discourse."
In one sense, Friedman said, initial disappointments at the national level can offer even greater opportunity to enact meaningful health policy in the state legislatures, in turn providing greater impetus for the U.S. Congress to revisit these topics in future years. For example, although there's little chance for any major federal policy gains until 2002, "One issue -- pharmaceutical drug costs -- will probably be addressed at a national level at that point because so many states will have acted on this very issue," Friedman said.
Which makes it all the more important for physicians to press for those goals in every legislative venue, she said.
"Stand up for what you believe in and act on it," Friedman urged. "Even if you don't think you can win, even if the politics are inscrutable, even if you can't see the light at the end of the tunnel -- be a voice."
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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