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From the Associate Editor's Notebook |
Associate Editor
HealthPolicy{at}arrs.org
The AJR's goal is to provide readers with the information they need to succeed in practice. Over the years, there have been several articles on the practice of radiology, including the one in this issue on the state of teleradiology [8], but about 4 years ago, we decided to expand on the socioeconomic area of practice, and the Policy Brief section was born, with me serving as editor. When I began writing and editing the Policy Brief section, I relished the opportunity to put into writing my ideas and thoughts on health policy as they relate to diagnostic imaging.
When one pontificates in public, it is easy to "hedge" and not necessarily prognosticate. In print, it is much more difficult to hedge your bets. Each Policy Brief, then, becomes a permanent record of my predictions and concerns. Even my choices of issues represent a statement of what I believe are the important nonclinical issues facing radiologists and health care at that particular time. I also have tried to encourage members of our specialty to understand the importance of issues that are not directly affecting our daily lives as radiologists. Thus, I have tried to explain and explore the uninsured, the current health care options for helping the poor in society, and the many contributing factors to the inefficiencies in our current health care "system." As well, I have solicited help in areas where I feel my own expertise is limited: We have been fortunate to have many exceptional guest editors and I hope this will continue.
In writing the Policy Brief column, I feel a strong responsibility to maintain balance. We all have strong personal views on politics, individual issues, individual candidates, and even more deeply personal feelings about narrow issues that affect us personally. It is impossible to be completely apolitical. The very issues that I touch on betray my political interests and passions. On the other hand, a good Policy Brief should leave the reader understanding the issues and the potential solutions, but not necessarily who, specifically, can or should solve them.
As the fourth anniversary of the Policy Brief series approaches, I thought it would be useful to take a look back to the beginning. Sufficient time has passed for me to determine if my early writings were off-base, on the-mark, or perhaps just irrelevant. I am pleased to say that I do not regret anything I have written. Furthermore, as the Policy Brief column has settled into its own home in the journal, I frequently get feedback from readers who appreciate the candor and detail that are captured each month.
In the first Policy Brief (July 2003), I began with a broad overview of the Medicare program. In that brief, I spoke about the reversal of the planned 4.4% reduction in the conversion factor for Part B payments. In subsequent briefs, I have talked about the specific issues surrounding the "Sustainable Growth Rate (SGR)" legislation and their impact on our practices. As I write this brief, it is possible that a very similar short-term fix will pass through the current "lame-duck" Congress. Whether it does or not, the SGR-legislated risks to patientcare access will persist until Congress rewrites this economically unwise piece of legislation.
In the second brief (August 2003), I gave a primer on how legislation is made and enacted. Within 3 months, the Medicare Modernization Act (which is unquestionably the most dramatic piece of Medicare legislation since the Balanced Budget Act of 1997) passed with wee-hour arm-twisting, latenight negotiations, and political drama playing out among disparate members of the House and Senate. In the near future, as committee memberships are settled, I will weigh in on my views for the future, based on the new leadership of the House and Senate.
In the third brief (September 2003), I was fortunate to have Jonathan Berlin write about malpractice reform. While this issue is less frequently talked about today, it is absolutely still of great importance to physicians and radiologists. When one reviews the policy agenda of many of the newly elected governors and state legislators, this issue is frequently at or near the top of their list of health care issues.
In the fourth brief (October 2003), I talked about the 43 million uninsured persons in our country. I talked about why I believed the problem would worsen without intervention from government. In subsequent briefs, I have explored some of the potential solutions. Suffice it to say that 2 years later (latest data from 2005), there are nearly 47 million uninsured individuals in America.
In the November 2003 brief, I opined on the health care issues facing our presidential candidates. I pointed out that Medicare solvency was such a critical issue that it needed attention, but also believed it would be sidestepped due to the volatility that it engenders. I still believe, passionately, that while it may be painful, solutions to Medicare today, rather than in the future, will be easier to tolerate and manage without merely shifting the problem onto our children.
In the final brief of 2003, I talked about the Part B (Supplemental Medical Insurance) part of the Medicare program. Of all of the posited solutions to its ever-increasing cost to the federal budget, I felt the current administration would work toward increasing enrollment in managed Medicare (which has since come to be known as Medicare Advantage). The Medicare Modernization Act, which passed shortly after writing this brief, did, indeed, encourage and promote this change. It is still too early to see if this will be successful, but enrollment has increased.
It is always nice to hear positive feedback on these Policy Briefs. I occasionally receive criticism. In such cases, we encourage the writer to either draft a counter-brief or even a letter to the editor. I greatly appreciate all the interest in these important topics. I continue to welcome ideas for future topics (whether you are offering to write a guest brief or merely suggesting a topic of concern).
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