Health Care Takes Center Stage on Political Left, Right

The AAFP's Scientific Assembly opened here yesterday with a couple of keynote speakers who packed -- and rocked -- the house.

Democrat Terry McAuliffe faced off against Republican John Kasich. With the country poised to elect a new president, the audience found itself privy to some spicy exchanges about political views between the two.

Kasich, a former nine-term Congressman from Ohio, said, "It's remarkable that this race is this close," and he called the campaign "a dog fight."

"What's going to matter are the debates. If John McCain can make Barack Obama look like his son, McCain will be president. If Barack Obama can make McCain look like his grandfather, Obama will win," said Kasich.

McAuliffe, former Democratic national party chairman and chair of Hillary Clinton's presidential campaign, called the election "historic" in that "we'll have the first African American president or the first female vice president of the United States."

"I've been in politics 30 years, and I've had every job possible in the Democratic party," said McAuliffe. He predicted sweeping victory for the Democrats this fall, but with this word of caution: "Anything can happen in this business. If there's any party that can screw this up, it's the Democratic party."

Although the audience clearly enjoyed the political jousting, most family physicians came to hear what the Democratic and Republican parties have to offer in terms of health care reform.

McAuliffe promised physicians they'd see major reform in this country. "The system today does not work. As Hillary's campaign manager, I did 15 cities a week for 18 months; the No. 1 issue people complained about was health care," he said.

"We're going to get health care reform because the public is demanding it. The whole Medicaid system is about to collapse," added McAuliffe.

Kasich agreed that a restructuring of the health care system was necessary, but said it was unlikely to happen any time soon. "I don't see any silver bullet coming. I don't see a leader who can fix it," he said.

Referring to the Medicare payment issue, Kasich said, "This business of you being in a fire fight every year is ultimately a losing proposition." We have to change the payment structure to reward the physicians "who keep people healthy."

McAuliffe told the sea of physicians sitting before him, "You are the most important people in the health care delivery system."

"We waste a lot of money on (sub)specialists who offer patients a lot procedures," said McAuliffe. After the procedure is done, the patient never sees that doctor again. He added that family physicians should be compensated for the work they do, and part of that work is disease prevention.

McAuliffe argued that physicians shouldn't shoulder the entire burden for keeping Americans healthy: "People have to take responsibility, too. If you want to smoke and sit around and eat Krispy Kreme doughnuts, that's OK -- but society shouldn't be responsible for taking care of you if you're not taking care of your own health."

How can physicians help push politicians to fight for health care reform? Get involved, said both speakers.

"Get into your PAC (political action committee)," said McAuliffe. "You've got to get engaged in the process. You are the first line of defense -- if you don't get involved, it ain't gonna happen."

Your PAC "gives you a voice," added Kasich.

And don't ignore what's going on in your own state, he urged. The states are beginning to take action on the health care front and governors are enacting legislation. "This may be a case where the ultimate resolution is something that goes through the 'laboratory' of the state," said Kasich.

He advised physicians to communicate with their elected representatives at all levels. "Build relationships. Help them in their districts … it's a long ongoing process, but you'll make progress," he promised.

"One final thing," said Kasich. "This is rough and tumble, but politics is not a sporting event." The polarization of people -- and the inability to talk to one another and to look for the good in one another -- needs to stop, he said. "No major problem can be solved on a partisan basis; it takes both sides to pitch in."