The day before the Governator delivered his State of the State address, he delivered a shock to doctors. He announced a wrongheaded plan to "fix" the healthcare system. It appeared that he didn't learn anything from his 2004 battle with other professionals dedicated to society's infrastructure--teachers, police officers and firefighters.

Gov. Schwarzenegger took his fight against those groups to an open forum with ballot propositions. He tried to convince the electorate that these public servants deserved less from the government coffers. The various unions representing these "special interests" spent in excess of $80 million to convince the public that his ideas stunk. The unions "terminated" his propositions. In 2005, he retreated, signing bills to please these groups
so he could dare to seek re-election. The strategy worked like a charm.

Give him credit! After the bitter battle in 2004, the governor might have recused himself from the pressing problems of our state. His biggest decision could have been what brand of cigar to smoke in his tent. That's why his pronouncement in December that he intended to "tackle healthcare in California" surprised many of us.

As physicians, we know that healthcare's systemic problems rest largely outside of our ranks. If certain groups came in line, we'd see much improvement in the system.

* If insurance companies paid our usual and customary charges in 15 days, earned minimal profits and lowered premiums, the problem would almost be solved.

* If hospitals treated doctors with respect, followed our lead and let us self govern, the goal would almost be achieved.

* If the government reduced regulations, stopped expanding providers' scope of practice and increased Medicare reimbursement, the solution would almost come in sight.

* And if people (patients) ate healthy foods, exercised regularly and followed doctors' advice, we could cross the finish line.

But his proposed plan didn't suggest such constructive things. It was more like a bomb that went off, causing more damage. Inside information revealed that Daniel Zingale, the first lady's chief of staff, developed the proposal. Once the plan was out, Republicans immediately distanced themselves from the governor. Tom McClintock went so far as to say that he would not have supported Schwarzenegger's re-election. Doctors honed in on one issue: a 2 percent surcharge (tax) on physician incomes to pay for the new program. Outrage poured out of the physician community. Immediately, many doctors called for a recall or a doctor strike.

In January, the Orange County Medical Association board of directors held a strategic planning session a week after the governor's announcement. Fortunately, Joe Dunn, the new CEO of the California Medical Association, attended. He spoke on a topic with which I identify. He demanded that we stop whining and act like DOCTORS. He advised that we use the public's vision of us to our advantage. Although we train in many specialties and practice in many different settings, we remain doctors at the core. The word physician never caught on with the public. Like it or not, doctor is our professional title.

Dunn revealed that more powerful forces than us will take issue with Schwarzenegger's plan. He admonished us to seek the greater good and address the issue that has been the focus of many House of Delegates discussions: universal coverage. The CMA's previous attempts to accomplish this lofty goal have failed, but 2007's opportunity must not be sacrificed based on petty fights about small details.

The governor's plan as presented cannot pass muster. But 2007 has potential. The CMA has a chance to participate in the creation of equitable, rational and feasible healthcare reform. We doctors need to collect our ideas, share them within our ranks and then allow CMA leadership to craft the best reform package for the governor to sign. Time is of the essence. Our fight is for the patients--the people of California.

Lytton W. Smith, MD, editor for the OCMA, is a physician practicing family medicine with the St. Jude Heritage Medical Group in Yorba Linda. Dr. Smith welcomes feedback on his articles and can be reached at editor@socalphys.com.