EDITORIAL
J Oral Maxillofac Surg
Where Were You When the Health
Reform Law Passed?
“I am tired of hearing it said that democracy doesn’t
work. Of course it doesn’t work. We are supposed to work
it.” — Alexander Woolcott
Where were you when the health reform law, the
Affordable Care Act passed? Perhaps it would be more
appropriate to ask where you were while the bill was
being developed? Did you make any effort to impart
the unique knowledge you possess as an oral and
maxillofacial surgeon to those creating this bill?
Despite the enormity of health reform and the tan-
gled web that health care policy weaves in our soci-
ety, most of us limited our participation to watching
from the sidelines and “Monday morning quarterback-
ing.” Why does that occur? Apathy? Laziness? Lack of
knowledge about the issues or how to contribute to
the process? Distain or distrust of the political pro-
cess? For those of us content to live with what we are
dealt any of those may be sufficient. For those who
are not, none are acceptable.
Believe it or not we have all been invited to the
dance and can choose whether or not to attend. If we
do go, we will note that there are many dance part-
ners and interestingly enough we each may occupy
many roles in the dance. Allow me to provide some
examples.
As a health care professional, the rules and regulations
imposed by health care policy on the business aspect of
our practices should be enough to get our attention and
spur comment or action. The “red flag” rules, proposed
1099 requirements for expenditures over $600 and
pending electronic health record requirements are but a
few examples. Likewise, our primary responsibility,
which is patient care, is interfered with on both an overt
and more subtle basis. Our abilities to provide patients
with timely and appropriate care can become entangled
in bureaucratic mazes that end up in denial of care at
one extreme or subtly alter the patterns of practice of
healthcare providers so that pitfalls can be avoided,
potentially to the detriment of patients who do not
receive the most appropriate therapies. Mechanisms de-
signed to finance health care clearly affect our ability to
develop sustainable business models with well trained
staff and current technologies.
As a patient and recipient of healthcare, I have differ-
ent concerns. I want the best care available and at a
reasonable cost. I want to have the right to choose with
whom I entrust my care and ideally there should be
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sufficient providers from whom to choose. I would like
access to the latest technologies, pharmaceuticals, and
surgical techniques that have been shown to improve
outcomes for diagnoses that I have. I would like to have
some reasonable assurance that my ability to get appro-
priate care in the future will not be dependent upon my
age, diagnoses, or past claims history. If I change jobs I
would like to be able to keep my chosen healthcare
providers or be able to transfer care seamlessly.
As a taxpayer, I want a healthcare system that
allows for timely cost effective quality care. I want the
doctor-patient relationship to be unencumbered. Pre-
vention of disease, evidence based healthcare deci-
sions and a renewed emphasis on the importance of
individual responsibility in living a healthy lifestyle
should be prominent in all taxpayer supported mod-
els. Politicians and policy makers must consider the
tough decisions necessary to control cost such as
end-of-life care, evidence-based decision making, and
alternative reimbursement mechanisms that reward
effective care not volume of care.
As a small business owner I have other concerns. I
want opportunities to provide medical benefits to my
employees but not regulations mandating that I do so.
The benefits need to be cost effective and deductibil-
ity as a business expense is important. I want to be
able to offer my employees quality health care and
options. I want health care policy that provides some
assurance of stability so that I can plan for the future.
As you can see from the four perspectives illus-
trated above, even one person can struggle with iden-
tifying the attributes that belong in healthcare policy.
What works for me as a healthcare provider may not
work for me as a small business owner or a taxpayer.
What am I to do? What you shouldn’t do is sit on the
sidelines and watch. I would suggest introspection,
education and engagement. Consider the issue of
health care from some of the perspectives noted and
consider others that might be pertinent to you. Edu-
cate yourself about the issues and solutions recom-
mended by other stakeholders. Inquire about the po-
sitions of your legislators.
Engage policy makers and make your opinions
known. Do this in your community, state and in
Washington, DC. It is important to be involved, be it
through OMSPAC, the AAOMS OMS Action Network,
your state OMS society, or on your own time. How
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else can we expect elected officials to take the posi-
tions we want them to take unless we impart our own
knowledge and concerns to them.
The legislative process has often been described as
similar to making sausage. There are a lot of ingredi-
ents that are combined to create a whole. Each ingre-
dient lends something to the final product and may
alter the flavor. We may not get everything that we
want but we should savor everything we get into the
mix, provided we take the time to get involved.
EDITORIAL
“The most important political office is that of private
citizen.” — Louis Brandeis
DANIEL J. KLEMMEDSON, DDS, MD
IMMEDIATE PAST CHAIR, ORAL AND
MAXILLOFACIAL SURGERY POLITICAL ACTION COMMITTEE (OMSPAC)
© 2011 American Association of Oral and Maxillofacial Surgeons
doi:10.1016/j.joms.2011.01.020