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AAMC Reporter: December 2006
A Word from the President:
"Reaffirming the Principle of the Public Good"
With the November elections now behind us, and the
potential for our country to take a new direction, I want
to reprise the theme I sounded at our annual meeting
last month in Seattle—the need for our nation to reaffirm
its commitment to the principle of the public good
and the role our nation's medical schools and teaching
hospitals can play in leading this change.
Throughout our great history as a nation, we repeatedly
have embraced the notion of the public good, believing
that some goods and services should be provided to all
members of society, or at least made available for all
members to access. Support for higher education
through the land-grant university movement, the
founding of the first charity hospitals in our oldest
cities, the establishment of the National Institutes
of Health (NIH), and the creation of Medicare and
Medicaid—each is an expression of our nation's commitment
to the public good.
But when we look at the country today, we find the
concept of the public good "missing in action"
from the national conversation. So-called hot-button
issues appear to divide us, and partisan posturing in
Washington seems to have replaced reasoned debate.
As a society, we have stopped demanding support for
the public good and, in many instances, have regressed
to putting individual interests ahead of the common
objectives we share as a nation.
Closer to home, the core missions of academic medicine—education, research, and health care—historically
represented three of our nation's most fundamental
public goods. Today they are in danger of becoming like
any other commodity, subject to the whims of the marketplace.
Median tuition levels at medical schools have
tripled since 1984, making a medical education practically
out of reach for many Americans. In research,
inflation is outpacing increases in the NIH budget.
Increasingly, investigators are turning to the private
sector for support, and when they do, they are finding
that pharmaceutical companies are investing more in
clinical trials and less in discovery-stage research. In
health care, nearly 47 million Americans are left sitting
in the uninsured cold, with millions more underinsured.
Reaffirming support for the public good is a daunting
task. It will require tough social conversations we long
have been avoiding, putting our collective social goals
ahead of specific institutional goals, and in some cases
making personal sacrifices. But I firmly believe that
academic medicine is uniquely positioned to restart
this national conversation.We sit squarely at the intersection
of three of the most vital public goods—higher education, scientific discovery, and health care.
However, we can exert this kind of leadership only if we
get "our own houses" in order, and that means starting
with a critical reassessment of our pursuit of institutional
self-interest and the ways it obscures our pursuit
of the public good. Among the measures I called for our
community to consider are rethinking legislative earmarks,
instituting some form of caps for medical school
tuition, supporting important research even if it is
unprofitable, and giving "mission" as much weight as
"margin" when making tough choices about clinical
services. Additionally, we must work to create a "rhetoric-
free zone" where reasoned discussions about these
issues free from partisan posturing can take place.
I was heartened by the many supportive comments I
received from the membership after my speech. But I
was especially surprised by the number of individuals
who called my remarks "courageous" or "bold," because
I did not consider them to be either when compared to
the tremendous courage members of our community
show every day, whether it is managing trauma cases
or training the doctors we will trust to care for our
loved ones. Upon reflection, I believe the message with
which the audience resonated was our shared readiness
to apply this courage collectively, as a community, by
leading the way in reaffirming our nation's commitment
to the public good.
The idea that our nation has reached a tipping point
about the need to reaffirm the public good is one that
I heard expressed repeatedly during my first five months
at the AAMC; first, in my initial meetings last summer
with leaders inside and outside academic medicine
and, more recently, at the annual meeting when New
York Times columnist David Brooks described how
Americans have grown weary of polarization. And it
would appear from the recent elections that many
candidates tapped into this all-too-painful vein of
voter discontent.
While the winds of change are blowing through the
nation's capital as well as many statehouses, what matters
most is not the number of "R's" and "D's" who have
been elected but what we collectively demand of them.
Nov. 7, 2006, was not the end of the political process,
but the starting signal for us as an electorate to decide
what we are brave enough to insist upon.
As I closed my Seattle speech, I noted that Winston
Churchill once said, "You can always count on
Americans to do the right thing—after they've tried
everything else." In recent years we appear, as a nation,
to have tried everything else. Now is the time for us
to do the right thing by working to restore one of our
most cherished ideals. Medical schools and teaching
hospitals cannot wait for someone else to go first. We
should strive to energize this long-overdue national
restatement of our priorities and reaffirm higher education,
scientific research, and health care as public goods.
Darrell G. Kirch, M.D.
AAMC President
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