President's page: forging change in health care policy--the principle is the thing.

Depending on how you look at it, seven years is either a long time or a mere blip on the cosmic clock. In the universe of politics and government agencies and special interest groups, it’s definitely more akin to the latter. And so it is now that, after seven years, the American College of Cardiology (ACC) and health care providers across the country are on the verge of an important victory: the enactment of a meaningful “patients’ bill of rights.” While nothing in Washington is ever guaranteed, there seems to be a nearly unstoppable swell of support for this legislation. Indeed, President Bush not only chose to speak in March at this year’s ACC Annual Scientific Session (ACC 2001) in Orlando, Florida, but he also chose to make the patients’ bill of rights the focus of his speech. As I said at the time, I believe that the president’s decision to speak at ACC 2001 is not only a testimony to the quality of the meeting, but also to the important and expanding role the ACC now plays in the health policy arena. This belief was reinforced less than a month later, when I was invited to appear before the House Ways and Means Subcommittee on Health to testify on patients’ rights legislation. Sitting alongside leaders of organizations and corporations that both support and oppose a patients’ bill of rights, I told the committee how important this legislation is to patients and physicians, why it’s needed, and why— after seven years of debate—it’s needed now. It may be surprising to hear that, if history is any indication, enactment of this legislation is right on schedule. Even wildly popular legislation must grind its way through the congressional gears, starting and stopping like an oilstarved car engine. The Brady Bill, for example, which had the endorsement of former Presidents Nixon, Ford, Carter, and Reagan, and overwhelmingly broad public support, took approximately seven years—from 1987 to 1994—to become law. Patients’ rights legislation has also had wide public and congressional support. In the fight for enactment—which the College* has been engaged in from the beginning— however, the devil has definitely been in the details. As such, the College’s role in this battle serves as a good example of the kind of persistence required to successfully influence the development and passage of broad-scope legislation. It’s an example that we should all keep in mind as we continue our advocacy efforts on issues like the uninsured, Medicare reform, physician reimbursement, and regulatory relief. More likely than not, achieving change in these areas will take time. And more often than not, it will take far longer than we think it should.