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Why participating in politics is the right thing to do

From the October ACP-ASIM Observer, copyright © 2002 by the American College of Physicians-American Society of Internal Medicine.

By Robert B. Doherty

Many Americans view "politics" as a world of sleazy politicians bought by moneyed interests cutting back-room deals that put the interests of their contributors over the public interest. Because of their disillusionment with politics, many Americans choose not to participate in politics.

Although politics may not be as pure and public-spirited as we would like, it is a mistake to dismiss politics as unworthy of our interest or participation. As columnist Mark Shield once put it, "Politics is the way that democracies resolve legitimate conflicts without resorting to violence."

Viewed in this light, we are all obligated to participate in the political process. By engaging in politics, we help resolve legitimate conflicts without violence. Rather than being unworthy of our participation, politics should be viewed as a basic obligation of citizenship in the world's most democratic society.

Politics and professionalism

Many physicians no doubt share the public's disillusionment with politics and therefore choose not to participate. Some have even argued that by refusing to participate in politics, they are taking a principled position, because politics is fundamentally inconsistent with professionalism.

Professionalism holds that the interest of the public must always supersede the interests of the profession itself. Politics would violate the ethos of professionalism, the argument goes, because it would inevitably result in the medical profession using the political process to further its own economic self-interests, and not the public interest.

For much of the 20th century, many physicians and professional societies accepted this argument. Many chose to focus exclusively on the science and art of medicine and ignore politics and advocacy. The American College of Physicians, for instance, didn't become actively involved in the political arena until the mid-1970s.

The view that professionalism was inconsistent with political advocacy was not universally accepted, however. Other medical organizations—including the AMA, state medical societies and the American Society of Internal Medicine (ASIM)—eagerly embraced political advocacy as an essential part of their mission.

Nowadays, very few medical professional societies view political advocacy as inconsistent with professionalism. Every specialty society has some kind of representation in Washington, and most have expanded the resources they put into political advocacy.

The merger of ACP and ASIM may have symbolized the end of the debate over politics vs. professionalism. The merger brought together two organizations that embraced the traditions of professionalism and political advocacy on behalf of patients.

A new charter on medical professionalism, published in 2001 by the American Board of Internal Medicine, the European Federation of Internal Medicine and the ACP-ASIM Foundation, stated that "professionalism needs to be founded on the primacy of patient welfare and on social justice, including the fair distribution of health care resources." It also claimed that physicians should advocate for "just and adequate access for all patients ... ."

ACP-ASIM is among the organizations that endorsed the charter. Politics is no longer considered to be in conflict with professionalism; rather, it is viewed as an obligation of medical professionals.

By advocating for fair Medicare reimbursement and an end to excessive paperwork, we are helping to assure that elderly and disabled patients will continue to have adequate access. We advocate for legal reforms to address skyrocketing medical liability premiums because we believe that excessive liability costs are reducing patient access to essential services and diverting resources from patient care to attorneys' fees. And we advocate for reforms that will guarantee that all Americans will have access to affordable health insurance coverage by the end of the decade, because universal coverage is a prerequisite for a fair distribution of resources.

Member participation in politics

Still, too few ACP-ASIM members are actively engaged in political advocacy. Approximately 2,000 members have signed up to be key congressional contacts, meaning they agree to be alerted to upcoming congressional votes and to contact elected lawmakers to support ACP-ASIM's advocacy positions. Unfortunately, those 2,000 key contacts represent less than 6% of the entire College membership.

Consider another figure: Only about 150 internists from 35 states participated in Leadership Day, a two-day program held each spring in Washington. This event gives College members first-hand knowledge from Washington insiders about key legislative issues. They can apply that knowledge by visiting lawmakers in the capital and during chapter-based advocacy throughout the year.

It is not that ACP-ASIM doesn't appreciate the efforts of members and chapters who participate in the key congressional contact program, Leadership Day and other advocacy activities. We do, especially because we know how difficult it is for internists to find the time to contact their members of Congress. It is just that we as a profession can—and must—do better.

The Washington office is taking steps to make it even easier for ACP-ASIM members to become involved in the political process. Our Legislative Action Center helps ACP-ASIM members monitor the status of key legislation issues and send e-mails or faxes to members of Congress. The process takes about five minutes and requires you to have Internet access and know your zip code.

We have also set up a toll-free legislative hotline (888-218-7770) so College members can call their elected lawmakers directly at absolutely no cost. We are expanding and improving the key congressional contact program, including moving towards e-mail versions of our legislative alerts so that key contacts can click on a link in the e-mail and go directly to the Legislative Action Center. And we are working with chapters on expanding participation in Leadership Day.

I am interested in hearing from College members about their perspectives on participation in the political process. (You can reach me at 800-338-2746, ext. 4530, or by e-mail at rdoherty@acponline.org.)

Is it a question of lack of time? If so, what can ACP-ASIM do to make it easier for you to participate? Is it because you don't know how to participate in the political process? If so, what can we do to better explain the "hows and whys" of advocacy?

I know that some of you are probably just so turned off by politics that you don't think it is worth your while to participate. If so, I'd ask you to consider the following observation from sociologist Kenneth Clark: "We can destroy ourselves with cynicism and disillusionment just as effectively as by bombs."

In my mind, the future of the medical profession—and the patients you serve—depends on how many of you reject the voices of cynicism and disillusionment and instead join with the College in advocating for just and adequate access for all patients. We're here to help you do that. Just tell us how.

Robert B. Doherty is ACP-ASIM's Senior Vice President for Governmental Affairs and Public Policy.

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