Christopher M. Hughes, M.D. is a practicing physician, a trustee of the Pennsylvania Medical Society, and the Co-Director of Critical Care Services at St. Clair Memorial Hospital near Pittsburgh, PA. He is an avid blog reader (and writer) and the state director for Doctors for America in Pennsylvania. In this guest post, Dr. Hughes shares his perspective as a physician working to deliver the proper care to his patients in a troubled health care system. 

When health care reform was on the national agenda 15 years ago, some physicians supported it, but many did not. More significantly, organized medicine did not. That, I'm pleased to say, has changed.

We've seen a sea change in physician opinion and in particular, in the actions of organized medicine. The AMA -- yes the historically conservative, anti-reform AMA -- has thrown its support behind the House Democratic bill and AMA leaders are working with the Democratically-controlled Senate.

I think the reason for the change in attitude is that we physicians are in the trenches fighting for our patients. We know what the current system is doing to the practice of medicine. We know it is harming our patients.

That day to day experience overwhelms physicians' fear of loss of income and reduced "competition" in the private health insurance market.

The public is told to fear rationing, though we and they live with it, day in and day out. We see the patients who end up in our emergency rooms (and in my ICU) because they could not get timely care because they cannot afford it. A letter writer to The New York Times put it eloquently:

Emergency rooms are for emergencies. They can treat a patient in a diabetic coma, but they cannot provide continuing help in managing diabetes. They can treat a full-blown asthma attack, but they cannot provide the medications needed to manage asthma daily. They can treat a woman who has gone into early labor, but they cannot provide prenatal care. Emergency rooms cannot offer any help for managing Parkinson's, Alzheimer's or cancer. On a more basic level, they cannot provide eyeglasses, hearing aids or dentures.

Reform opponents create a PR whirlwind of breathtaking horror stories from Canada and Britain. Have you heard the one about the woman who could not get treatment for brain cancer in a timely manner in Canada? It turns out it was a benign cyst, not cancer. It did require treatment, but it was not life threatening. Sorry, we physicians have all seen worse stuff right here in the United States. We have seen the cancers grow from treatable to end stage because there was no insurance. We see the diabetics descend into ketoacidosis because they cannot afford their insulin.

We see the work of Remote Access Medical, which gives thousands of the uninsured rural poor a once-a-year-chance at getting to see a doctor. That work was a factor that turned former insurance company executive Wendell Potter into an advocate for reform. And it illustrates a point  made by Malcolm Gladwell:

A country that displays an almost ruthless commitment to efficiency and performance in every aspect of its economy -- a country that switched to Japanese cars the moment they were more reliable, and to Chinese T-shirts the moment they were five cents cheaper -- has loyally stuck with a health-care system that leaves its citizenry pulling out their teeth with pliers.

You cannot frighten physicians with tales of "government bureaucrats;" we deal with insurance bureaucrats day in and day out. The disturbing incentive in the private health insurance market is to reduce the "medical loss ratio," which is an Orwellian way of saying that money actually spent on medical care is a "loss." Executives, employees and stockholders benefit when less is spent, and it shines through in our interactions with health insurers. I have yet to have Medicare do a "rescission" on a patient, nor refuse to pay for a hospital stay because of a "pre-existing condition."

You cannot frighten physicians with worries of government inefficiency; we see inefficiencies built into the current system, with wars of attrition being fought among patients, providers and insurers. Can you submit the correct form to the correct place in the correct way the correct number of times to get covered? I have been in practice 15 years in my current location and my billing company keeps a running tab of the now more than 250 different insurance entities they have dealt with just for me, a solo practitioner. This eats up 7 percent of my income and I don't even have an office (just an ICU). It costs an office practice over $85,000 per physician per year to play these games.

Physicians want to do the right thing by our patients. And not just the ones in front of us.

The American College of Physicians published in 2002 a Physician Charter on Medical Professionalism in the New Millennium that articulated clearly the duty of physicians not only to those in front of us, but to all patients, our communities and our nations to advocate for social justice, particularly in the fair distribution of resources. We are to work actively against discrimination in health care, to demand a uniform and adequate level of care, and to scrupulously avoid superfluous tests and procedures.

This charter has been adopted by the AMA and at least 50 other specialty and international physicians' groups. It seems the majority of these organizations are walking the walk. Most of the large physician organizations have declared their support for broad principles of health care reform that are largely based on equitable distribution of health care resources, or at least a floor for health care access.

So, why are physicians for health care reform this time around? Well, "Why not?" is one easy answer, but, I am proud to say, I think the real reason is, "Because it's the right thing to do."