Health Reform's Shortest Era
He came. He saw. He vanished. Just as we health care journalist types were lining up the margins and checking references on our various predictions of what Tom Daschle would bring to the health reform debate and process, he bequeathed his White House office to his deputy in waiting. Then, instead of conquering, he promptly left town—for good, it would seem. If it weren’t so painful watching the quadrennial succession of self-absorbed politicians condescend to those actually working in health care, it would be comic in the extreme to contemplate the level of absurdity that so-called reformers occasionally thrust upon our profession. We saw it in 1992, and I thoroughly expect that we will see it again with the individual tapped to be the next HHS secretary. We knew it was coming with Daschle because he told us so in his book, which is now destined for bargain bins and garage sales across the land. Is it so hard to expect that we could find a grownup to work on health reform—one who truly understands the profession and all that it contributes? Of course the profession has problems that need fixing. Everyone knows that much. It is getting harder, however, to find someone with true moral authority to lead the way forward without doing further damage in the process. Daschle's was the shortest era of the many health reform eras, and yet we should spend some time analyzing just what his agenda might have brought to health care in general, and to medical imaging specifically. It will be important to dwell on this because it is likely that his ideas will continue to influence those of President Obama, if not specifically those of the person who ends up running the health bureaucracy itself. We get to start all over again with the speculation game—or do we? No matter who leads the charge to redo what virtually every opinion leader understands is a very expensive (yet mind-numbing) patchwork system, medical imaging will remain under the closest scrutiny, primarily because it represents the fastest-growing segment of health care spending. In essence, the new era has already begun. We are in the midst of what will become increasingly intense debates and policy discussions focused on reining in the costs of medical imaging. The ability of those in the imaging field to control their destiny, future, lifestyle, and contribution to the continuum of care will be critical to finding new ways to harness these debates to the advantage of the profession. If we truly believe that medical imaging is efficacious, helps offset and control overall health expenditures, saves lives, and contributes to the body of knowledge to the greatest advantage of society, then we need to get in the game—especially now that a brief respite has been delivered while a new HHS secretary is recruited. Whereas Daschle cited most of his data and knowledge about imaging (at least in his book) as coming from National Imaging Associates (the huge RBM), perhaps there is now an opportunity for the ACR, the Medical Imaging & Technology Alliance, the RBMA, the American Healthcare Radiology Administrators, and others with interests allied to medical imaging to coalesce around a new and persuasive argument to posit to the new administration. We need to get our story told, and get it told to those in positions of influence. We need to tell it with one voice, and with a clarity that will persuade legislators, regulators, and payors to focus elsewhere when seeking categorical reimbursement cuts. We cannot allow ourselves to become prey to those who would seek to make headlines at the expense of medical imaging’s health. Let’s build the right coalition of stakeholders and begin outlining the tenets of medical imaging’s story. We have a new opportunity to get it right, and a whole new audience to influence.