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what we (the other me's) worry about most



I spent the first weekend of March in New Orleans at the annual AMSPDC meeting. That is the Association of Medical School Pediatric Department Chairs. This group represents the departments of pediatrics from each of the LCME-accredited (only the allopathic schools; not any of the osteopathic schools) medical schools in the country, as well as the 16 allopathic medical schools in Canada. We come together yearly to enhance our ability to network with each other, to enhance mentoring of junior chairs by those more senior, and to discuss our common problems and issues, for brainstorming, mutual support, etc.

This year many of our discussions revolved around Medicaid. We talked about which states were trying to change medicaid (pretty much all of them) and whether what they were trying to do was good for patients or not. Very few of us were totally happy with how their states were addressing medicaid from the standpoint of how it will affect the children we care for. You see, whereas children represent at least half of all medicaid recipients, they consume only about 20% of the medicaid resources.

Few states are focused on making medicaid better for children. They are almost all concentrating on how to cut costs due to budget shortfalls in nearly every state. Some states are changing medicaid eligibility so there are fewer covered individuals, and that includes children. We therefore are worried that children will receive less medical care; some will receive no preventive care. We worry that this will mean less recognition and treatment of chronic illnesses; less prevention of adult diseases like obesity and hypertension. We worry that this will mean more adults will have more significant illnesses, require more treatment as adults, and end up costing all of us more in the end.

At the conference there was a statement that caught on. I am not sure who initiated it: "While not every child will be an adult, every adult was once a child."

If we don't take care of this country's children, what will happen to the adults? If kids do not grow up healthy, how can we expect the United States to compete with the rest of the world in academics and engineering? If kids do not grow up healthy, maybe they won't grow up at all. It costs much less money to prevent serious disease than to treat it, once it is established. It is much less costly to provide the medications and education for a child with asthma to keep them out of hospital, than to deal with the adult whose lungs are permanently damaged.

As a group of leaders in North America we are worried. We want to speak with one voice. We want to join with other pediatric groups such as the American Academy of Pediatrics, and others to convince our elected officials at both the state and national levels to protect the health of our children. Every other physician group should join us in this quest, for in speaking for children we are speaking for the future adults. Let's hope someone is listening.

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