Medical Student Perspectives: The Importance of Advocacy
With the passage of the Patient Protection and Affordable Care Act (PPACA) on March 23, 2010 the nation now faces a complex and multidimensional set of changes to the health care delivery system. The passage of the bill was just the beginning of reform, and there remains much debate regarding the implementation of PPACA. The current discussions over the provisions of the law illustrate the importance of advocacy in defining the future of health care.
PPACA already faces the challenges of repeal, budgetary shortfalls, and Constitutional invalidation. Yet, assuming that PPACA remains largely intact, it will be the decisions surrounding its implementation that will truly define the meaning of reform. At this point in time, the true meaning of PPACA has yet to be determined.
For medical students, now is a prime opportunity to become involved in advocacy. The decisions made now will directly impact us in our careers as physicians, and your input merits consideration. While this requires some time to educate ourselves on the current reform, and to contact our representatives, it is time extremely well spent. One example of how reform is right now taking shape is the current debate over Accountable Care Organizations (ACOs).
PPACA calls for the creation of ACOs, and generally defines them as groups of providers that are tasked with coordinating patient care and improving efficiency. The bill, perhaps intentionally, uses vague language and states that ACOs will "promote accountability for patient populations," and, "redesign[e] care processes for high quality and efficient service delivery." It is the regulations put out by the Centers for Medicare and Medicaid Services (CMS) that will better define the role and composition of an ACO. Those regulations, published on April 7, 2011 are now awaiting the feedback of numerous interested parties in the form of public comment. The regulations are neither simplistic nor superficial; they span 127 pages of the Federal Register. It will be the detailed and in-depth comments of highly interested parties with specialized knowledge that determine the ultimate form of these regulations. This perfectly illustrates the current importance of advocacy. The passage of the PPACA is truly only the beginning of reform.
Advocacy generally is important to the formation of sound public policy. It can be difficult for a representative to independently gather all of the specialized knowledge required to make an informed decision on a particular issue. Rather, representatives rely on the input of the public, especially those with extensive knowledge of the issues.
Ultimately, the most important skill in policy making is accurately predicting the consequences of law. These consequences can be far reaching and may impact a vast array of people directly and indirectly. All decisions have benefits and drawbacks, and it is important for the points of view of those affected to be heard.
A final point is that your time and effort in advocacy is not wasted; an individual can in fact have a very big impact on future policies. At a recent briefing in Washington, D.C., Linda S. Birnbaum Ph.D of the National Institutes of Health said that, "I can't tell Congress what to do, but I can certainly urge them to consider all the new science." As PPACA is further defined in the coming months and years, we will need to rely on the sound reason and thoughtfulness of constituents to determine the direction of health care.
ACP provides numerous resources for medical students to become
involved in advocacy, including:
- which provides updates on key issues and aids members in contacting their representatives. Form letters are often provided to members who can sign on, but are urged to send their own personalized message.
- which is an event that is part educational and part advocacy. The first day offers briefings on current issues; on the second day, members participate in visits to the offices of their representatives in Congress. Here, you can have your voice heard directly.
- - an award winning policy blog which features up-to-date information on current issues.
- - Applications will soon be accepted for the 2012 health policy internship positions.
D.H. Slade
ACP Health Policy Intern
Southern Illinois University, Class of 2012
E-mail:
dslade@siumed.edu