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A Word from the President: From the Politics of “Hope” to the Politics of “Anger” — Where Do We Go from Here?

AAMC President and CEO, Darrell G. Kirch, M.D.

With the midterm elections now behind us, it is remarkable what a difference two years can make. The mantle of positive change and hope worn by so many candidates in the 2008 election seemed to have been replaced in the 2010 campaigns by a wave of national anger. Many of us are reeling from a case of “political whiplash.” Despite this sense of dislocation, however, we should not lose sight of all of the positive changes that have occurred over the last two years for our community in the arena of federal policy and legislation. As the year draws to a close, it seems an appropriate time to take stock of the major achievements for academic medicine in the current Congress and assess the outlook for medical education, research, and health care as the 112th Congress convenes next month.

Since 2009, two historic pieces of legislation have helped reshape the political landscape for our community—the American Recovery and Reinvestment Act (the “Recovery Act,” or ARRA) and the Affordable Care Act (ACA). Together, these laws have created new programs and provided strategic investments that present novel opportunities for innovation across our missions and the promise of improved health for our nation.

The Recovery Act, signed into law in February 2009, provided an unprecedented $10 billion to the National Institutes of Health to explore bold ideas that address critical gaps in basic biomedical and behavioral sciences and have the potential to speed the translation of research into improved health. In addition, this funding has provided key resources and technologies that lay the foundation for new fields of scientific inquiry, while allowing more students to experience the excitement of biomedical innovation.

Recognizing the looming health professions workforce shortage, the Recovery Act also provided $500 million for workforce development through 214 new National Health Service Corps scholarships, 4,000 additional loan repayment awards, and $200 million in grants for health professions training programs. Recovery Act dollars also are helping with health professions diversity and public health workforce training programs, including the funding of preventive medicine residencies.

In addition to bolstering biomedical research and the health professions workforce, the Recovery Act appropriated $1.1 billion for the emerging field of comparative effectiveness research. These funds are being used to encourage the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data.

The second political watershed moment for our community—and for the nation—came with passage of the Affordable Care Act in March 2010, the most comprehensive change to our health care system since President Lyndon B. Johnson signed into law the Medicare and Medicaid programs in 1965. This complex law provides many opportunities for academic medicine, including the creation of a Center for Medicare and Medicaid Innovation (CMMI) within the Centers for Medicare and Medicaid Services. The ACA names AAMC-supported Healthcare Innovation Zones (HIZs) as an option to test new payment and delivery models to improve quality and slow the rate of Medicare cost growth, two goals of the CMMI. We are especially excited about the transformative potential of HIZs and are actively working to advance the concept into practice.

The ACA also created a Patient-Centered Outcomes Research Institute (PCORI). Designed to assist “in making informed health decisions by advancing the quality and relevance of evidence” about the treatment of health conditions, the PCORI is an important step forward. I am delighted that two members of our community were chosen to lead the PCORI Board of Governors. A. Eugene Washington, M.D., M.Sc., vice chancellor of health sciences at the University of California, Los Angeles (UCLA) and dean of the David Geffen School of Medicine at UCLA, will chair the new board, and Steven H. Lipstein, president and CEO of BJC HealthCare in St. Louis, will serve as vice chair. In addition, representatives from four other AAMC-member institutions will serve on the governing board.

Despite these positive developments, significant challenges lie ahead. Our nation continues on an unsustainable fiscal course of historic budget deficits and an ever-mounting national debt. The federal budget deficits in 2009 and 2010 were the largest, as a share of the nation’s economy, since the end of World War II. There is a growing chorus of calls in Washington and across the land to freeze federal spending for the next several years, and some legislators are talking about rolling domestic spending back to 2008 levels. The Obama administration signaled the tough budget climate ahead when it instructed federal agencies last June to assume a 5 percent decrease when preparing their FY 2012 budget requests.

While much has changed over the last two years, our core advocacy priorities will remain steadfast as we work to create a better future in the realms of research, education, and patient care. The challenge for our community moving forward will be to work with the administration and the new Congress in this climate of fiscal austerity to take advantage of the opportunities created by the Recovery Act and Affordable Care Act to expand our knowledge base, train a diverse health care and scientific workforce, and develop meaningful innovations in the delivery system. Our advocacy for our missions will be stronger than ever, and we remain firmly committed to work together to address the health care needs of the 21st century.

Darrell G. Kirch, M.D.

AAMC President and CEO