The American Medical Association recently gave unqualified support to the House health reform bill, H.R. 3200, and that is drawing the ire of some of their supporters.
To be sure, H.R. 3200 is the most left-leaning of the proposals, and there is clear ideological opposition to the so-called “public plan,” which expands the government’s role in our health care system. It’s a tremendously sensitive topic, with some expressing their outrage (to put it gently) in private e-mails to me.
The AMA has joined other professional societies, including, the American College of Physicians, the American Academy of Family Physicians, American Academy of Pediatrics and the American Osteopathic Association, in support of the bill.
The Wall Street Journal, however, wrote a scathing view of the AMA’s support. In today’s lead editorial, they write that the AMA, along with other lobbying groups, are “putting their short-term self-interest — usually ensuring that government programs remain generous (enough) — ahead of the long-run threats.”
I’ve previously written that it’s tremendously important for doctors to present a unified front, since it’s easier to ignore fragmented voices. But, should doctors support the current, albeit seriously flawed, reform efforts?
I believe the answer is yes, and I understand that there is significant opposition to that stance. Despite reservations about the current approach, including, the threat of a “strong” public plan that uses Medicare (under)payment rates, it does remove the unacceptable sustainable growth rate formula that determines Medicare physician reimbursement, which is a much-needed step forward. Furthermore, it makes an attempt, admittedly paltry, at increasing the pay of beleaguered primary care doctors, who will form the backbone of any reform effort. Is that far too little to settle for? Perhaps.
But a more important question is, what if reform doesn’t pass? It’s quite possible that preserving the status quo will be far worse for doctors going foward than the current proposals. I also believe that it’s important for doctors to “get a seat” at the table, lest they be marginalized further if they don’t.
I cited a quote from Paul Krugman a few months ago, where he wrote something along the lines of, “the perfect is the enemy of the good.” He was referring to the single-payer supporters and grassroot reformers who felt that Congress’ proposals didn’t tilt enough to the left, and as such, oppose the current efforts.
I think that sentiment goes both ways. Some reform is better than none, and doctors advocating for a free market-based system shouldn’t hold out, hoping for the perfect package.
It’s not coming anytime soon.
Related posts:
- The biggest threat to President Obama’s healthcare reform efforts comes from his own party
- How to get doctors to embrace health care reform
- How to convince doctors to accept health reform
- Convincing doctors to accept a public health care plan option
- Support for the patient centered medical home in the House health reform bill
- Should a public plan option be part of any health reform initiative?
- 10 health reform posts you may have missed
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Spot-on observation anon 9:16. A huge portion of the 47 million uninsured are in their boats by their own doing and their own choices.
Speaking of choices, trusting the government to do what it said it would do – and handing the “businees” end of medicine over to non-profiteers was a HUGE mistake that I made fairly early on in my career. I’ve been paying for that naivete ever since.
It simply amazes me how many people are willing to take the path of least resistance, ignore ALL of the evidence right in front of all of us, and fall into the same traps over a decade later.
Obama fear-mongering at a Children’s Hospital yesterday made me want to barf.
When the government this Pediatrician once served faithfully and well . . . the government that stood by DEAF, DUMB and MUTE as she got the huge CLUSTER-SCREW . . . steps in to make things right, that will be change I can believe in.
Not holding my breath.
As an member of the AMA since medical school with nearly 3o years in the organization, a former county, state, and national officer, and a private solo Family Physician for 20 years, I am appalled by the AMA support for HR3200. We are being sold out. We need reform, not destruction. Medical care is given when needed by primary care physicians and those specialists in the community that can and will provide the support. But, as medicine is touted as a safe “job” for the future, we are having many enter the field who are in it for the money, not for care.
With all due respect to Presdent Rohack, this is the wrong bill, at the wrong time, with the wrong priorities. We need liability reform before payment reform. We need an emphasis on preventive instead of curative care. And we need to reestablish that the AMA is advocating for physicians and patients, not other providers (RN’s, PA’s, Psychologists, etc.) that the current congressional leadership feels can be used to “rein in” medical costs. “Efficient” medical care does not need EMR’s and rapid transit of claims. It needs specialists to see patients in the same time frame as PCP’s. It needs legal reform to stop the lottery of malpractice that leads to unnecessary and wasteful testing. It needs Congress and the states to stop unfunded mandates and provide meaningful direction on what will and will not be covered and why. It needs a lot more than Congress is willing or able to talk about right now. The AMA should withdraw its support of HR3200 before it becomes a flip-flopping pariah and useless mouthpiece for political correctness instead of the strong physician advocate it has been.
After nearly 30 years of membership, I have to wonder whether the AMA has left me before I leave it.
KJE
Ok, it’s time to take a time out.
I understand the passion that health reform brings out. But comments on the blog must take a civil tone.
Doing otherwise, such as including personal attacks and unrestrained ranting will be deleted immediately.
Dr. Johnson, I have received several requests that you cease referring to your experiences where you were unfairly treated. We all sympathize, and I’m sorry that happened to you, but we get the picture. You do not need to refer to them in every comment.
So, from here on forward, any further mention of them will cause your comment to be deleted.
Furthermore, I continue to reserve the right to delete any comment on this blog for any reason at any time. And I do not need to explain what my reason is.
That’s it. Now carry on.
Kevin
Dr Rohack, closing your comments to commentary is the same as telling your mother to keep her mouth shut. Both are rude and disrespectful.
Moving on…
Certainly, increasing access to care for all American’s is noble. Certainly removing pre existing conditions as a prerequisite for insurability is necessary.
The empowerment you speak of is jibberish. We have a cost control problem in this country. This bill does nothing to control costs. We are paying to much to too many people to do too much. Putting your full weight behind a bill that accelerates the bankrupting of this country makes the AMA part of the problem.
Do you want your grand children to pay the 99 trillion dollar bill come due in their life time?
I would support a bill that hold physicians accountable for the care they provide. I would support a bill that holds patients accountable for the care they receive. I would support a bill that holds government accountable for the money they provide.
Right now, Obama and company ( you included) are supporting a bill that holds no one accountable for anything.
By choosing access over cost, you and your organization will go down in history as one of the many that fed from the trough, claiming to compromise on everything, yet solving nothing.
Let me get this straight:
“Maintaining the status quo is not an option and the AMA is committed to achieving health reform this year that provides all Americans with affordable, high-quality health care.”
I’m focusing here on the words “affordable” and “high-quality”. The services we provide fall under the engineering rule: Fast, Cheap, Good: Pick 2. So, if we follow the rules, that means a long delay in receiving healthcare, right? This is where we’re going… Rationing by delay, as has been seen in Canada and England. No thanks.
Why do you state that the status quo can’t continue? If it is so fundamentally broken, why does it work so well? Why must we accept the “reform” being offered to us, rather than demanding better? The bill does not improve care for the majority of americans, but rather imposes conditions on the marketplace that likely make care for the majority worse. That would, in my mind, make it a bad bill.
If we want personal responsibility then we should not require doctors, hospitals, etc to treat patients without payment. We should have a special fund to clean up the mess when necessary. Those that choose not to carry insurance live (or die) with the conseqences.
No doctor contracts with insurance companies or medicare/medicaid and price transparency. If the insurance doesn’t pay what the doctor wants, the patient can fork over the rest or go without treatment.
Have a medical injury fund which compensates patients for medical errors. Refund the patient’s money and review the competency of the doctor.
When I go to a restaurant, if I don’t like the way the meal was prepared, I can request they take it back and redo it to my liking. Why cannot these so-called public servants take their “reform” back to committee and keep taking it back until they get it right? Don’t they work for us? Or am I wrong?
Dr. Pho, Dr. Rohack, at the risk of having my voice at your table moderated out, according to DRUDGE this evening, the President of the United States is not completely familiar with the specifics of his own healthcare reform bill – the one he wants to ram down our throats in a matter of weeks:
http://www.heritage.org/2009/07/21/morning-bell-obama-admits-hes-not-familiar-with-house-bill/
Here’s the audio:
http://www.realclearpolitics.com/video/2009/07/21/obama_not_familiar_with_key_provision_in_health_care_bill.html
Yet we, as physicians, are supposed march blithely and blindly behind this man . . . and the AMA?
Dr Johnson,
Yeah, when someone just made up something pure and simple about the House bill, Obama wasn’t familiar with that because it’s a flight of fancy. I can see that it’s the right-wing meme du jour, popping up from Michelle Bachmann and heading out from there, but it’s BS, and no wonder that Obama was not “familiar” with it.
SF
Respectfully shadowfax, what you brush off as “made up” or a “flight of fancy” appears rather to be a reasonable set of deductions based on the language of the bill (as well as what we have seen happen in the past – of course, I can’t refer to personal experience) of what could happen as this bill is currently written.
In short, ramming this thing through with little real imput from doctors (apart from the AMA) and practically ZERO debate demonstrates an alarming lack of foresight.
We’re already dealing with loads of “unintended consequences” of other laws passed as knee-jerks to one problem or another (HIPAA and HCQIA come immediately to mind).
P.S. Be careful. “BS” might be perceived by some as “unrestrained ranting”.
Even the President admits these bills all need work -
Obama, asked on NBC’s “Today” show whether he would sign any of the bills working through Congress, said, “Right now, they’re not where they need to be.”
http://www.reuters.com/article/domesticNews/idUSN208242420090721?sp=true
Physicians are being sold a bill of goods with this. The government never steps away from something with this many votes at stake. It merely gets in deeper, no matter how poorly this “reform” goes. If it stinks, it will only be evidence that we need MORE government.
Why the AMA backs this I have no idea, as the only option for physicians to take back their time and control of their livelihood is by backing away from the third party payment model.
Kevin asks this question: “But a more important question is, what if reform doesn’t pass?”
Then you still have a lot of control over your future. Currently about 50% of the cost of healthcare is paid by the government. Do you think this “reform” will increase or decrease that number? If it’s the former, how does this help the physician? Does his/her bargaining power INCREASE against the federal government?
Right now you still have a lot of patients out there that could transition to a more direct payment system. As more and more pay via their taxes, their appreciation for your work goes down (after all, I pay my taxes, where’s my healthcare?) and your ability to be paid more based on your skills declines.
In no way, shape or form is this good for physicians. And as a result, it’s not good for patients either.
I can understand the blogs of the above members, including Dr Johnson. I LOVE medicine but I honestly hate the SYSTEM that FORCES us to comply and takes away our freedoms. EMTALA, HIPAA, Red Flag Rules, HIT/Outcomes Research, and CMS/Medicare Audits all have ATTACHED PENALTIES for non-compliance. No wonder MORALE among physicians is at an all-time low. TOM DASCHLE—especially in his book “Critical”, unilaterally blames PHYSICIANS for the cost of health care. He FAILS to SPREAD THE RESPONSIBILITY to hospitals, PHARMA, and Insurance Companies—-why? Because—Daschle is a HIGHLY PAID LOBBY member representing these entities. Daschle wants a FAST/HASTY passage of “ANY form of reform” in order to PREVENT OPPOSITION. The AMERICAN PUBLIC has no problem forking-over millions of dollars to athletes, entertainers, politocians, and lawyers. Are they getting a BETTER PRODUCT today versus in the 1950’s or 1960’s? In medicine, more people are SURVIVING today versus in the 1950’s and 1960’s—–including TRAUMA, pediatric/neonatal, and the list goes on. Yet our society COMPLAINS on spending for those areas that IMPROVE their quality of life. Final Point——our biggest enemies in government are OVERSPENDING and HIGH TAXES. Until we stop punnishing the small businesses and professionals in this country, it will be hard to get back on our feet. Like Dr Johnson and many other physicians, I feel that most of my work and sacrifice goes to taxes and pleasing government—-yet what I get in return is increased REGULATION —-and unlike other SMALL BUSINESSES, I DO NOT feel that I have the same rights as other small business owners—or for that matter, the same rights as administrators in the health care system.
There can’t be a right to any one’s labor. If a “right” like that exists, what other “rights” are we unaware of? The right to food? The right to a shelter? The right to clothing? How is the distinction being made that health care is a right, without referring to who is to provide that right?
I find it so easy to find docs everywhere who are against health care reform. They don’t want government involved. They don’t want patients having access issues. They are against rationing. They don’t want death panels (expect for Billy Mallon)….really??
Let me summarize it for you, they don’t want to change. Someone is threatening to move their cheese, and they are mad about it.
http://www.em-blog.com/blog/2009/9/2/i-am-against-health-care-reform-by-dominic-bagnoli-md.html
As a first year I have a lot of ties to people practicing within the field. I agree reform needs to happen but why would we leave reform up to lawyers/politicians. Isn’t that a conflict of interest. The AMA has made a mistake by quickly rushing out and supporting a bill rather than saying, “we support healthcare reform and but at this time have not seen a bill which we feel addresses the core principles that need reformation”… if something like that was said they could still cover their behinds as well as accurately represent their members.
The other side of reform that I rarely see addressed is the physician shortage that will ensue. My brother in law is an anesthesiologist and has cut back hours as to stay under a tax bracket. My uncle is considering moving to a cash only practice (he has already stopped seeing medicare and medicaid patients, not because he is in it for the money but because he doesn’t have the time to deal with the piles of paperwork and other issues that follows patients using that type of payment). As well, several Emergency Rooms within the town I live in have converted to urgent care clinics. From my understanding this is so they aren’t stuck with treating patients that don’t have insurance. Its scary to imagine what other ‘changes’ will manifest as health care reform is passed. Its like influenza, its not a matter of if, but when.
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