An Uncontested Election

Health care is a collection of all sorts of different threads.

Hopefully by the time this issue of Sierra Sacramento Valley Medicine reaches you, our national presidential election will have finally been decided. When I learned I would be President of SSVMS, I did not realize the advantages of an uncontested election: I did not have to run a huge campaign, my expenses were small (try nonexistent), and certainly the campaign stress was minimal.

But after the national presidential campaign, you, the members of SSVMS, may look back and feel somewhat cheated in your own society presidential election.

Had the election been contested, you would have heard about the candidates, their backgrounds, and their vision and goals for SSVMS. Let me, now that the election is over, give you a statement on my background and visions for the future. If, based on what I say, you demand a new election, all I can say is, California is not Florida, and appeal to Bill Sandberg and the Board of Directors for resolution.

Don't worry, the paragraph on my growing up will be brief. I grew up in Staten Island, New York, and moved to Des Moines, Iowa, at age 13. Then I went to college and medical school in Chicago, internship in New Orleans, and residency and fellowship in Sacramento. I have lived in Sacramento for 27 years, and never regret my westward migration.

I have worked for the Veterans Administration, the U.S. Public Health Service, in a University teaching hospital, and finally in a very large medical group, The Permanente Medical Group. While at Permanente, I have experienced fee-for-service in a very limited way: certain patients have paid cash for their colonoscopies.

While at Permanente, I have also assisted medical malpractice attorneys with the defense of malpractice cases. This has been educational for me in many ways, both in learning about other specialties, and experiencing Monday morning quarterbacking at its worst.

Why am I serving as President of SSVMS? My practice is busy and the health plan I am affiliated with is continuing to pay the bills my medical group submits on my behalf. Why should I be interested in solving the problems of other styles of medical practice? My philosophy can best be explained by comparing health care to my wife's needlework.

My wife, Irene, is the creative member of our family. She takes needle and thread and canvas, and creates a masterpiece. She has a vision, a plan, she mixes different colors of threads and different stitches, and the end result is wondrous.

Health care is a collection of all sorts of different threads: there are different styles of practice, from fee-for-service to loosely affiliated groups of various sizes, to large groups, and finally to government practice. Each style has its advantages and disadvantages. Some fit well for a given specialty. Forcing another style onto that established practice creates a finished piece that just does not look right. Certainly that is what has happened with many forms of managed care.

But there is no one color of thread, no one stitching style, that suits everyone. It is the variety of colors of thread and stitching styles that creates the masterpiece. In the Sacramento valley area, we need all the different delivery systems we now have. No one system is best for all of our patients. And when one system is in trouble with either finances or access, every system suffers.

Take, for example, the difficulties Emergency Rooms in our area experience when even one ER is overwhelmed. That ER goes on diversion, the other ERs get all the ambulance traffic, they become overwhelmed, and every ER suffers. For each hospital that closes for whatever reason, there is one less ER in the area to handle the collective volume of care required by the community as a whole.

I am committed to the health care of our region. I feel that SSVMS serves a vital role in overseeing the provision of health care. It is uniquely qualified through the vast expertise of our collective membership to comment on the problems and work toward solutions of health care in the Sacramento region.

Serving as your President, I hope to convey to everyone who will listen that the health care system in the Sacramento Valley is intertwined and interdependent. One cannot afford to allow any portion of that complex system to be underfunded and ultimately deteriorate.

robert.midgley@kp.org