"Better bend than break."

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This Scottish proverb may provide guidance for those lawmakers, physicians and organizations who feel unwilling to accept the proposed changes in U.S. healthcare reform because of their vested interests. Widespread changes seem to be inevitable under the current Administration, and solutions recently introduced in Congress have stirred a great deal of controversy, mainly based in fears of too much government interference. However, most agree that some changes to the U.S. healthcare system will be enacted within the next year.

As ACC CEO Dr. Jack Lewin has said, the "nation is poised to take on this tough issue now."

President Barack Obama spoke to the American Medical Association (AMA) at its meeting in Chicago on Monday, touting the need for reform, particularly the need to ensure coverage for every American. In an attempt to appeal to the organization, Obama called to curb malpractice lawsuits and cancel a proposed 21 percent cut in Medicare payments, which would result in a $41 billion cut to hospitals.

Despite the President's appeal for support, on the same day of the AMA speech, the American Hospital Association (AHA) sent a letter to the administration, conveying its "deep disappointment and concern" about the proposed additional $220 billion in cuts to hospitals, which would be added to the $41 billion in cuts to hospitals, proposed by the Administration.

Lewin, who attended Obama's speech, said that the "nation must move forward and expand access and coverage to all Americans, and also use the momentum of reform to fix the SGR, to improve quality of care, and to institute payment reforms that promote quality and effectiveness."

The ACC has proposed a payment reform option, organized around participation in CMS-approved clinical registries, through which physicians would be paid by a combination of budget neutral fee-for-service and virtual bundled bonus payments that would be aimed at rewarding effective practice and improved patient outcomes.

Additionally, Sens. Max Baucus and Kent Conrad have proposed a comparative-effectiveness bill which would seek to establish a private, nonprofit corporation that will research and compare clinical outcomes of alternative therapies and health strategies. However, Sens. Jon Kyl and Mitch McConnell introduced an opposing bill that could potentially block the legislation, arguing that the research would lead to rationed healthcare, eventually delaying treatment and weakening the quality of care.

While this debate rages on, decision makers and organizations may be judged more by their ability to compromise on these issues, and less by ability to be stalwart and unbending.

On these topics, or any others, please feel free to contact me.

Justine Cadet