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lenge the mandate for insurance. (We cannot have universal coverage without some sort of mandate; our AMA policy is that we have individual ownership that is portable.) No commercial market can survive without the mandate if the pop- ular guaranteed issue is part of reform. We may litigate our way into a single- payer system as probably the only viable option. The U.S. government pays for 40 percent of all care now.


TMA has said all along that we want


to keep what is good, get rid of what is bad, and add what is needed to the Af- fordable Care Act. And we have written it down.


In this time of disruptive change, we cannot just say “No.” We have to help re- organize the medical marketplace so that it creates more value for those who pay for it. We have to help reorganize the medical marketplace so it gives us the right to practice in the ever-expanding public system, with the option to con- tract privately with patients who want more.


The good news is we spend such a


large amount of money on health care that if the doctors who know how to treat are allowed to organize, we can cover everyone for basic services and we can cover advanced care for those who want it. U.S. Rep. Tom Price’s bill on pri- vate contracting is the start of a terribly important legislative battle for American medicine.


Another new trend is doctor employ- ment. TMA wants to be relevant to all doctors in Texas, no matter how they are paid. We know that doctors need to be protected from some corporate methods, but like any innovation in medicine, or- ganization of new care systems is cru- cial. So we introduced novel legislation to protect employed physicians’ clinical autonomy. To satisfy the value proposition: We


have to reorganize the medical market- place so it delivers the right care at the right place, at the right time, and at the best price. Good medical care will never be cheap. Prevention can be.


Focus on the future Looking ahead, there will be more reg- ulation through the Independent Pay-


New TMA Alliance President Bridget McKeever, left, takes the oath of office from outgoing President Doris Johnson. Ms. McKeever said, “I know that my collaboration with Dr. Bruce Malone will inspire me to take on new challenges to serve the medical family.”


July 2011 TEXAS MEDICINE 11


ment Advisory Board. There will be major changes to Medicare and Medic- aid: President Obama’s devastating cuts versus Congressman Ryan’s vouchers that shift costs to individuals. There will be limited panels on commercial insur- ance based on cost efficiency, an urgent matter. We cannot just say “No” to these


changes. We have to offer a better way to our patients, to the government, to the private insurers, and to the employ- ers. We have to reorganize the medical marketplace. We need private contract- ing to give us the ability to work within the public system no matter how misdi- rected. We need more patient choice. We are often not very focused in our legislative agenda. We have opinions about everything and get real results on very few. The best result we have achieved in my memory was the 2003 tort reforms because we were focused. We have to keep our eye on the real prize in this reform. We cannot just say “No.” As physicians, we must defend our autonomy or risk being dumbed down. We must create new forms of practice while making care safer. Finally, if we work with our patients in mind, they will support private con-


tracting because they will have more choices, and we will have more auton- omy and the ability to continue to inno- vate and advance technology in practice. We are so fortunate to have our life’s


work be meaningful and valuable, com- bining increased population productivity with the privilege of being part of our patients’ lives. So let’s roll up our sleeves and meet the challenges. Let’s stop say- ing “No” to the change all around us; some of it is very necessary. Let’s be leaders in reorganizing the medical mar- ketplace.


When we meet these challenges just


as our predecessors have done, with sci- ence and innovation, we will be helping to create a unique American system of care that works for us and that works for our patients.


I hope you all will help.


Dr. Speer named TMA president-elect


The TMA House of Delegates voted Mi- chael E. Speer, MD, president-elect on the final day of TexMed 2011 in Hous- ton. The Harris County Medical Society


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