“State Senator Jack Hatch addresses AAFP Legislative Conference”

Guest column: A lot is riding on health-care reform

Below is an excerpt of remarks state Senator Jack Hatch of Des Moines plans to deliver to the American Academy of Family Physicians in Seattle today. When I address health-care groups, I always include in my speech this political mantra, "Don't forget, it all started in Iowa." With the debate on health-care reform in full swing, Iowans know of our participation in the pivotal moment in American politics when we gave then-Sen. Barack Obama his first presidential caucus victory. Now, the credibility of his first term is riding on Congress approving his promise, and actually [that] of all Democrats, to reform the health-care system in America.

The Senate and House bills would provide coverage to millions of the uninsured by expanding Medicaid and subsidizing private insurance for people with moderate incomes. In reality, there are differences between the two congressional bills, but the political discourse is disturbingly limited to a few issues like abortion, the government's public insurance option and financing. What is missing in this debate is the enormous level of agreement on the fundamental changes Congress is making on how we deliver health care in this country.

Here is what the Senate health bill promises for American families: - An end to the insurance industry's discriminatory practice of higher insurance premiums for women. - An end to refusing coverage for pre-existing conditions like cancer, diabetes and heart disease. - A new open marketplace for buying insurance, with new choices for insurance including a public option free of insurance company profits. - $347 billion over 10 years to expand state Medicaid and SCHIP [health care] programs for children.

- $447 billion in credits for working families to better afford quality insurance coverage. Simply put, reforms means: choice, quality and guaranteed health care for families in America. For our parents and grandparents, the Senate bill will strengthen Medicare: It will provide free preventive care; shrink the Medicare drug benefit "donut hole" by $500; reduce the costs of brand-name medications; and work directly with doctors to improve quality of care and develop new systems to reward doctors for quality care.

The Senate bill, like the House bill, goes a long way to help America's businesses better afford health care for their employees. The bill offers $27 billion in premium tax credits to businesses, particularly small businesses, which offer employee coverage. Importantly, the bill promotes shared responsibility. All Americans will be required to have private or public insurance, with an exemption for those who can't afford it. And, save for the smallest firms, employers who choose not to provide employee coverage will pay a fee that will help those employees get coverage elsewhere.

But the delivery of services will change dramatically, and family physicians are a key to the success of our reform efforts. Due in part to the work of Dr. David Carlyle, a family physician in Ames, Iowa's own health reform legislation, similar to the congressional bills, requires the use of "coordination of care" initiatives. This is central to the fundamental shift from treating people when they are sick to keeping people healthy. Preventive medicine and managing chronic care are nearly forgotten in this debate.

The investment in Electronic Health Records (EHR) is universally applauded. Through the vision of the Iowa Health System and private doctor groups like the Iowa Academy of Family Physicians, Iowa will have the first statewide EHR system in the country. As the national legislation states firmly, connecting the patient directly and primarily to the primary care physician is the best investment we can make and the best medical process we can promote. Its future savings to the system, not to mention its contribution to higher quality and better care, is almost forgotten in the process.

Even though your association has been on record for these reforms, in this debate, the American Academy of Family Physicians must now speak louder for reform than ever before. This moment in history will not come around again in our lifetime. Of all the physician groups, your practice of medicine has the most important responsibility - you are trusted by your patients. Your future role will increase more than any other practice and your historic position to protect your patients by helping prevent future illnesses cannot be underestimated. As the Nike commercial states, "Just do it."