President Obama's speech to the AMA was a model of reason, clarity and vision. It raises the question of why the AMA needed to be lectured about the dilemma a doctor, particularly one in primary care, faces:

Our costly health care system is unsustainable for doctors like Michael Kahn in New Hampshire, who, as he puts it, spends 20 percent of each day supervising a staff explaining insurance problems to patients, completing authorization forms, and writing appeal letters; a routine that he calls disruptive and distracting, giving him less time to do what he became a doctor to do and actually care for his patients.

The President's speech even quoted Newt Gingrich: 

As Newt Gingrich has rightly pointed out, we do a better job tracking a FedEx package in this country than we do tracking a patient's health records.The speech reminded me of a conversation a few days ago with a close friend who said casually, "Face it, Abraham, medicine is corrupt."  I paused. I sputtered. I was about to say something. But I shut up.  I shut up because (as the President explains) whether I like it or not, I am a beneficiary of a system of :

 . .  incentives where the more tests and services are provided, the more money we pay. And a lot of people in this room know what I'm talking about. It is a model that rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can't spend much time with each; and gives you every incentive to order that extra MRI or EKG, even if it's not truly necessary. It is a model that has taken the pursuit of medicine from a profession - a calling - to a business.

We can quibble on the ways the President proposes to fund the changes he proposes, but I don't think we can quibble on the moral imperative to change the way we do business. As the President says,

"You entered this profession to be healers - and that's what our health care system should let you be."

(For another take on the speech from a thoughtful physician who also happens to be in New Hampshire, see

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