POLITICS: Across the Spectrum, Some Common Goals at the AMA

Ten years ago we couldn't even agree on the ultimate goal for health reform. Just a day ago, at the American Medical Association's National Advocacy Conference, I heard a whole lot of agreement on where we want to be -covering all Americans, providing better care, and reducing costs. Two very interesting perspectives on how to get there came from from Senators Ron Wyden (D-OR) and Tom Coburn, M.D. (R-OK).

Wyden and Coburn are of course far apart ideologically. But as I listened to them give their separate speeches, I was struck by how similarly they viewed our health reform challenges (if not how to achieve solutions). In particular:

• Both were very clear that 47 million uninsured is simply unacceptable for this nation
• Both advocated greater preventive and primary care services in the U.S. to improve health and reduce costs
• Both decried the amount of administrative waste in our current system (and as a doctor, I wholeheartedly agreed).

Not surprisingly, the Democratic Oregonian and the conservative Republican Oklahoman differed in their proposed approaches to creating a more sustainable health system. Senator Coburn opposed further regulation of insurance markets and doctors, made the case for the power of the free market, and supported tax credits to make insurance more affordable. Senator Wyden, who is a lead sponsor of a bipartisan compromise that already has more than a dozen backers in the Senate, supported requiring all Americans to purchase health insurance, along with market reforms and subsidies to make sure those insurance policies are accessible and affordable. Wyden envisions a system where insurance companies make their money by adding value to medical care rather than "cherry picking" the healthiest and lowest risk individuals.

We don't want to minimize the real differences between the approaches. But we're glad both sides are talking and that groups like the AMA are listening. These conversations can create a foundation for future constructive and bipartisan progress around a common vision of where we want to be. Now we've got to figure out, together, how we can get there.