After a year of partisan political warfare and rhetoric ranging from high-minded to hateful, Speaker Pelosi and colleagues have sent President Obama legislation "resurrected like Lazarus" (New York Times) from what seemed like legal euthanasia a short time ago.

Hospitals, the pharmaceutical industry, and too a lesser extent, health insurers all gained concessions to make the legislation more palatable to their bottom lines. Testy topics such as coverage for illegal immigrants and abortion saw compromises which will satisfy few. For physicians, numerous improvements were also achieved, including "Administrative Simplification for Physician Billing In Private Sector" requirements, encouraging MICRA-type reform, incentives for primary care, and more.

The American Medical Association (AMA), which gave the legislation "qualified support" in the latter moments of the process, issued this statement from AMA President J. James Rohack, MD: "Historic passage of health system reform by the U.S. House of Representatives is an important step toward providing coverage to all Americans and improving our nation's health system. Every day physicians see the devastating effect being uninsured has on the health of our patients. Physicians dedicate their lives to helping patients, and we have an historic opportunity now to do just that. While the House-passed bill isn't perfect, we cannot let the perfect be the enemy of the good when it comes to something as important as the health of Americans."

Click here for the AMA statement. The California Medical Association (CMA) has provided a more detailed summary of the legislation. For patients who are concerned, CMA notes "If you like your insurance, you can keep it. Grandfathers all existing coverage, including Health Savings Accounts."

The "Insurance Industry Reforms" bear printing here almost in full:

• Requires health plans to spend 85% of revenue on direct patient care vs profit and overhead.
• Requires adequate provider networks.
• Requires plans to publicly disclose information on claims payment policies, enrollment, denials,  rating practices, out of network cost-sharing and enrollee rights.
• Prohibits plans from denying coverage for pre-existing conditions.
• Prohibits plans from rescinding coverage when a patient becomes ill.
• Prohibits plans from setting annual or life-time limits on benefits.

Bottom line: The evidence-based impetus for all this effort is that access to care is a powerful factor in quality and length of life. Also, most everyone agrees that the health insurance industry has long been in need of corrective regulation. Beyond that, controversy will continue, revisions and even reversal attempts will ensue, and how it all plays out still remains to be seen.

The San Francisco Board of Supervisors this week adopted San Francisco's comprehensive secondhand smoke ordinance on its second reading. The new policy, introduced by Supervisor Eric Mar and approved unanimously, tightens up existing rules and helps SF to "catch up" with some other municipalities.

It will restrict smoking in many public places, including dining areas where food is served outdoors, waiting lines, building entrances, hotels, most bars, farmer's markets, taxicabs, and common areas in multi-unit buildings. The policy is the result of much effort by a broad coalition of health advocates, including the SFMS.

SFMS Past President Steven Fugaro, MD, who testified in favor of the policy on behalf of the medical society, reports, "This is a big victory for the anti-tobacco forces, and I am very pleased!"

Assuming the Mayor does not veto the ordinance, it will go into effect 30 days later. There will be a 6 month delay in the implementation of the outdoor dining provision. For coverage of the policy, click here.