CMA HOUSE OF DELEGATES 2023

Michael Schrader, MD; Ameena Ahmed, MD and Steve Heilig, MPH

The California Medical Association’s House of Delegates (HOD) is loosely modeled on our government’s Congress, although with less dysfunction and polarization. Elected delegates from around the state propose and debate policy for the CMA, using an online quarterly forum and the annual statewide meeting each October. The two primary avenues for this process are the “major issues” chosen each year for the CMA to research and report on for debate and adoption, and the yearround policy resolution forum, where any CMA member and delegation can draft policy statements for statewide debate.

The primary function of this work is to guide CMA’s advocacy work, a potent factor in our state, and sometimes national, medical and public health arenas. Policies begin at SFMMS, adopted by CMA and sometimes AMA, have been influential on many important topics, from reproductive health to end-of-life care and much in-between. Here’s a brief primer and update on recent activities.

Major Issues 2023

Potential major issues are submitted by each delegation and this year there were many to consider. A committee of the chairs of each delegation makes the selection in a sometimes intense and sometimes contentious democratic procedural meeting. Last year our “emergency” proposal, submitted just after Roe v. Wade was overturned, formed the basis for much debate and policy). The SFMMS this year submitted three topics for consideration: Drug Addiction, Treatment, and Prevention, Combatting Health Misinformation, and Addressing the Emergency Medical Services Crisis (including violence against clinicians). In this year’s process the final selections are (1) Artificial Intelligence in Medicine, including consumer health technology; (2) Climate Change/Action (Promoting Sustainability/Public Health), and (3) the new state Office of Healthcare Affordability. It’s thus a broad menu and CMA staff and leaders will prepare in-depth reports to guide CMA’s practical work on these topics.

Policy Resolutions

Resolutions may be submitted quarterly for online debate and eventual vote. For the upcoming batch the SFMMS delegation has submitted three resolutions for consideration. The format is a parliamentary “Whereas/Therefore” format, with a few evidence-based arguments leading to a statement that will become formal policy if adopted by vote. The three such statements we submitted minus the “whereases” and references due to space constraints, follow here:

Tobacco Endgame: Supporting A Generational Tobacco Phaseout of Sales

Authors: Ameena Ahmed, MD, John Maa, MD, Dennis Song, MD, DDS, Heyman Oo, MD

RESOLVED: That CMA support the concept of generational tobacco and vaping phaseouts of sales wherein those born after a defined year are prohibited from purchase of any tobacco products in their lifetimes; and be it further

RESOLVED: That CMA will work with interested elected officials and health authorities to develop and support plans and proposals for effective generational tobacco phaseouts; and be it further

RESOLVED: That this be referred for national action (AMA).

Reducing Harm from Alcohol and Funding Medi-Cal Access

SFMMS District VIII

Authors: Michael Schrader, MD, Andrew Calman, MD, PhD

RESOLVED: That the CMA endorse a “quarter-a-drink” tax on alcoholic beverages, with the revenues specifically assigned to bolstering reimbursement rates for healthcare providers (both directly and via Medi-Cal managed care plans) to achieve rough parity between Medi-Cal and Medicare rates for comparable services, and

RESOLVED: that CME support harm reduction strategies for alcohol related disease including public education, and increased access to inpatient and outpatient treatment, and

RESOLVED: that because similar Medicaid access problems plague many other states, that this be referred for national action (AMA).

Support for K-12 STEM (Science, Technology, Engineering & Mathematics) education to increase the physician pipeline among underrepresented communities.

Authors: Ameena Ahmed, MD MPH, Haining Yu MD, Roger Eng MD

Be it resolved that:

1. CMA support educational organizations that provide or promote science, technology, engineering and mathematics (STEM) education to K-12 students, with the intention of expanding pipeline programs to careers in medicine; and

2. CMA support STEM education that targets K-12 schools that disproportionately serve low income students; black, Latinx, and Native American students; and other socioeconomically disadvantaged students; and

3. That this be referred for national action (AMA).

Policymaking has long been likened to making sausage, an unappetizing process even if one favors the outcome. The CMA HOD on the other hand has long been a model of collegiality and reality-based debate (and SFMMS is particularly glad to have our own Past-President Lawrence Cheung MD as Vice-Speaker of the HOD, helping guide the complex deliberations). We also, due to the expansion of SFMMS membership in recent years, have a significantly expanded roster of delegates from all over San Francisco and Marin. If any member has questions or ideas for potential policy, please don’t hesitate to get in touch!

Drs. Schrader and Ahmed are the chair and vice-chair of the SFMMS delegation, and Steve Heilig is primary staff coordinator. Contact: heilig@sfmms.org