Both Don Berwick, MD, MPP, and Jerry Avorn, MD, argue that staying silent in the current climate is a choice, and not a good one for physicians.
Physicians have long expressed their opinions, but a pair of viewpoints by leading physicians in JAMA this week raise the bar in their call for colleagues to speak out in today’s challenging times, and to even directly engage patients.
In these times, not speaking out is itself a choice—and the wrong one, say former CMS Administrator Don Berwick, MD, MPP, now senior fellow at the Institute for Healthcare Improvement, Cambridge, Massachusetts, and Jerry Avorn, MD, professor of medicine at Harvard Medical School and Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital.
Berwick weighed in Tuesday with, “Moral Choices for Today’s Physician,” which argued that physicians and leading healthcare providers have a professional obligation to take a stand “in the face of social injustice” against disadvantaged populations.
“To try to avoid the political fray through silence is impossible, because silence is now political,” Berwick writes. “Either engage, or assist the harm. There is no third choice.”
Berwick offers a list of sins against patients of limited means, including the high cost of drugs like insulin and epinephrine, which for some patients are the difference between life and death. He’s no happier with the cost of newer agents. “New biologics of undeniable value are being priced at levels that are not just like extortion—they are extortion,” he writes.
Hospitals, Berwick says, “play the games” of a complex payment system that lacks transparency, leaving few resources for prevention and not enough for priorities like schools, housing, and jobs. He argues that the bigger problems in US social policy are not within healthcare, but in a criminal justice system that that imprisons too many, especially minorities; environmental policies that ignore science and displace populations; and refugee policies that “blame the blameless.”
Berwick recently discussed the merits of a single-payer healthcare system with Patricia Salber, MD, MBA, for The American Journal of Managed Care® podcast series.)
Getting Patients Engaged
In “Engaging With Patients on Health Policy Changes: An Urgent Issue,” published Friday, Avorn writes about the Senate tax reform proposal, which is now being combined with the House plan in conference committee.
Avorn argues that the speed and lack of transparency around the Senate vote made it impossible for most voters to understand that effects of a late provision that would cancel the individual mandate of the Affordable Care Act, which many experts say could result in higher premiums if healthy, young people stop buying coverage.
The idea of doctors discussing “politics” with patients has long been off-limits, Avorn notes. He argues that “a strong case can be made that rather than being a taboo subject, discussing transformational changes in healthcare coverage with patients could be seen as a core responsibility of all clinicians—physicians, nurses, pharmacists, therapists.”
“This is not simply a moral issue,” Avorn writes. “It is necessary to ensure the capacity of healthcare professionals to continue to provide patients with the healthcare they seek from us.”
Avorn calls on physicians to reach out to patients in writing about the aspects of the legislation that affect coverage and payment, under the provisions of the Health Insurance Portability and Accountability Act (HIPAA) that permit such communication. He even includes sample language.
It is clear, he writes, that many of the missed opportunities in healthcare reform would have benefited from physicians engaging in this way. Why, he argues, should the debate be left to the lobbyists?
Even a small effort would have “a substantial multiplier effect,” that could be expanded if major players like large Blue Cross Blue Shield plans sent mailings to members. Avorn argues this would not affect the tax-exempt status of some of these plans.
Short of that, he writes, “There is nothing to stop individual clinicians from taking these actions ourselves, by communicating directly with the patients whose care we have a duty to protect.”