Rescuing Our Destiny

Thank you for your advice, patience, and encouragement during this campaign.  You honor me with this opportunity to share my views with you today.

I'd like to address three critical issues.

The first is managed care.

The juggernaut of managed care has moved from sea to shining sea.  Opportunistic managed care companies prove over and over again that their primary concern is not the patient — but the bottom line.  They have replaced choice with gag-rules and hold-harmless clauses.  The time has come for us to control our own destiny and run our own companies. Just as we took control of our destiny with the formation of medical society spawned professional liability companies, we can combine efficiency, quality, and choice in the managed care arena.  Medical Savings Accounts can brighten the horizon further.

And, let's not forget what we did two years ago.  

In 1994, a firestorm from Washington threatened to radically change our nation's health care delivery system.  But the false prophets of government offered 1432 pages of suffocating regulations and bureaucracy.  They said that only full destruction of our system could lead to improvement.  They promised that from the ashes of the Phoenix would rise Utopia.  Of course, these are the same people who promised full disclosure in their administration.  They did not focus on the issues, but instead proposed a system built on  sham economics that could only lead to enormous tax increases, cost overruns, rationing, and the shackling of individual freedom of choice and the right of contract.

We said we would not go quietly into this abyss, this new Dark Age, a Dark Age of medicine.  The House of Medicine stood firm on principle to get us through those tough days.  The false prophets were exposed and their plan defeated.

My views about managed care are clear to you ... and, I must admit, they're probably not that different from the other candidates'.

But since my last campaign, I've seen the wonders -- and the frailties -- of medicine.  I've gained a fresh perspective -- not as a healer ... but as a friend and son who experienced the deaths of three people I loved: my Dad, Dominic and my wife's parents.

For me, these recent experiences have translated abstract theory into a searing passion to help secure the relationship between us and our patients as the very heart of American medicine. 

We must never lose the personal touch with patients and never fail to honor the patient's right of self-determination.  Both government dictated medicine and managed care in its usual form have the potential to destroy this sacred trust.

 

The 2nd key issue is: tort reform.

Professional liability has haunted us, our patients, and our families long enough.

For too long, we have tolerated a tort system that is unjust and inefficient.  In the June issue of The Pelican, I provided examples of the details and nuances of tort reform that a physician should know to negotiate effectively.  Our AMA proposal to adopt nationally California's MICRA law, with its $250,000 cap on noneconomic damages, is one example of a good shield.  But we also need a powerful sword – penalties for frivolous suits –  to stop the proliferation of lawsuits that have no merit whatever.

My experience in the reform of professional and tort liability stems from a combination of everyday medical practice and my legal background. I stand ready to use my experience to represent your position without retreat. I will not be intimidated.  In negotiations, I believe it is important to remember the words of John F. Kennedy: "Civility is not a sign of weakness and sincerity is always subject to proof.  Let us never negotiate out of fear but let us never fear to negotiate".

I am an experienced negotiator and debater.  In fact, on this critical issue, I've been proud to apply my expertise whenever needed.  When New York called, I met with the Governor's Commission.  When Illinois called, I debated Ralph Nader.  And when Florida and others called, I joined the fight.  I intend to engage my skills to help duplicate Louisiana's legendary tort reform success across the nation advocating our AMA position of California's MICRA.

 

The last issue I'd like to talk about – and the most important – is our vision for the AMA.

We must recommit ourselves to the core values that have been our guideposts for the past century and a half – including the democratic tradition that forges our rich diversity into a single, strong voice.  But also we must be a powerful beacon that lights the way to a future for American medicine that is never dimmed ... but glows ever brighter.

We must have a vision of physicians as an army of activists, not lamenters – activists who will protest draconian regulations, protect patients, and ever strengthen the best system of health care in human history.  We will see obstacles as our forefathers did when this great country was born in 1776, not as problems but as calls to action, as spurs to our success.

We must have a vision of scientific excellence and scientific achievement.  We stand on the shoulders of visionaries and it is up to us to continue the medical miracles they've given us.  Think of your own experiences. How the marvels of discovery during our lifetimes made it possible to experience the thrill of cure of previously incurable diseases and injuries.  Our capacity for achievement is limited only by our imagination and courage. 

We must keep alive for the youth of America the dream and enthusiasm of high achievement.  As we have been privileged, so we must preserve for them the privilege to use the unlimited creativity of the human mind to solve the mysteries of the universe and blaze new trails in uncharted territories.

  Vision is the ability to imagine what's beyond the horizon and make it real.  Leaders, artists, scientists, and physicians who have vision not only see, they create.  Our job and the job of the AMA is together to create our future. 

My dad was a policeman.

When I was a boy, my friends and I would sit fascinated as Dad entertained us with stories of  capturing the seemingly uncapturable criminals.    His message always was:  do your homework, have courage, and don't give up.

We saw a good illustration of that third value last year in the movie Apollo 13, as the NASA team and the three astronauts marshalled their collective wills and creativity to return safely home. The engineer who solved, for all Apollo flights, the critical cooling system problem of the spacecraft told me the movie was very authentic. That brilliant engineer is Raymond French...who also happened to be one of the kids who sat with me as we listened to Dad's tales and his admonition: "Don't give up!"

Dad believed this to the end of his life.  I remember vividly my dad in ICU.  Two doctors stated they believed he could not recover and recommended discontinuing the respirator.  They believed he no longer was aware of his surroundings.  I asked dad if he wanted to live and put a pen in his hand and held a pad against it.  A nurse walked in and said "you are wasting your time."  I replied, maybe you don't have the time for this, but I will take however long it takes to try and communicate with my dad."  Then dad began to write, very slowly and in a childlike scrawl: "Yes. Don't give up."  We didn't give up and dad left the hospital.  He died last year – but his message lives on in his son.  I will never give up...We  will never give up.

Taking back control of our own destiny.  Tort reform.  Igniting and delivering a compelling vision...at the heart of which is Dominic Palmisano and people like him...who look to their doctors for help ... and healing ... and hope -- for life itself.

This is what I will fight for...this is what the AMA will fight for...and we will never give up!

If you will empower me with the position of trustee,

I will remain enthused,

I will do my home work, have courage, and not give up!

I will not go along just to get along or to advance myself but instead will carry out the duties of a fiduciary and thus honor your trust – always mindful that when the discussion ends, we go forward together with the consensus view and majority vote.

I will strive to see that Medicine is to be not just endured– but enjoyed!

This and more I promise.

I appreciate this opportunity and this honor, and I ask for your vote for Trustee to serve our AMA and our patients:  Remember, Palmisano – A strong voice.  A clear choice.  Thank you.

Donald J. Palmisano, MD, JD