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.
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I skimmed all ~1000 pages of the house bill and ~600 pages of the Senate HELP bill. These bills are NOT ready for prime time. There are lots of weird budgetary allocations without a clear explanation of what they’ll be DOING with the money – other than creating a committee to decide what to do later on. That’s just NOT ok. We’re not even close to having a “good” bill that could be an enemy of perfect. Seriously – go read some of this stuff and you’ll be shocked. I was.
Act in haste, repent at your leisure.
In other words, rushing without understanding the proposed reforms, for some temporary or even imaginary benefit, is likely to be a course more foolish than moving slowly.
Physicians will always have a seat at the table, and they don’t lose it by objecting to the stillbirth that is Obamacare.
@SarahW: I don’t think it’s true that docs will always have a seat at the table, as a matter of birthright. In the past when docs refused to be at the table unless we got everything we wanted, we were left out, and bad things happened. If docs get obstinate, we will be left behind, with our only recourse being the rear-guard actions and passive aggressiveness of the past 2 decades. Note: This DOESN’T mean we have to abandon our principles. It merely recognizes that we aren’t the only players in this game.
@kevinmd I don’t read the AMA support as unqualified. There was enough nuance in the AMA statement to suggest that they don’t think it’s perfect, but is the best place to start working on the details.
Kevin, I am sorry, but from my perch in the “cheap seats” of medicine . . . having taken the-beating-of-a-lifetime at the hands of the way over-paid, way over-rated business-school grads running my hometown “non-profit” hospital . . . non-profiteers who got a free pass/suffered no scrutiny whatsoever because government oversight is a fundamental joke . . I am sick and tired of the notion that physicians have to compromise . . . that “some” reform (no matter how fundamentally “not ready-for-prime-time” it is) is better than no reform.
That’s how we landed in the boat we’re currently in . . . from a tort system that is totally out-of-control . . . to a fundamentally useless system of medical peer review . . . to privacy regulations that often defy common sense . . . to the entitlement programs endemic to our 50-year old welfare state that do absolutely NOTHING to set reasonable limits or encourage personal responsibility.
I’ve told my friends, I never should have gone to medical school. I should have dropped out of high school when I was barely out of my teens, had five or six babies by multiple fathers (never marrying any of them) and lived happily-ever-after in public housing – never working a day in my life.
As someone who did work her arse off and went to school and got the education (only to be told by the idiots running the aforementioned “non-profit” that, “Good Pediatricians are a dime a dozen.”), I’ve been footing the bill for other people’s screw-ups & happy pursuits (in one fashion or another) my entire life, getting royally screwed in the process. And I’m DONE.
Bad laws were passed in a hurry because people caved or compromised or were just not paying attention.
The status quo is letting it happen again. NOW is exactly the time for foresight and dissent . . . lots of dissent . . . for doctors to stand up to their lameo “advocacy” organizations and say, NOT NO, BUT HELL NO!
I personally don’t give a rat’s tail what the AMA and AAP want, because they were NEVER there for me.
OBTW, I double-dare you not to moderate this out.
A reposted comment from the earlier topic today, but it seems more appropriate to this topic here…
The case for health reform often hinges on, “Something has to change”, or “Change is inevitable, and we should be there helping to shape it”.
The fallacy in this is that we must accept the changes proposed as good, right, and proper. However, if we see them as deeply flawed, and likely to do more harm than good, we are duty-bound to oppose them, and indeed, seek to ensure that the efforts at reform fail. Change for its own sake is simply stupid. There should be a rational cost-benefit analysis, and that is simply not being provided by those “shaping change”. Further, we are being marginalized regarding any real decisions regarding reform; rather, our presence serves to validate a politcal process that has very little to do with medicine.
At this point, rather than allow ourselves to be used as scapegoats for the horror that has so far been presented to us as reform, we should have the courage to denounce it for what it is: a naked power grab that has nothing whatever to do with medicine, and is all about expanding the role of the state. We are physicians, not politicians. By supporting this “reform” we are moving out of our caregiving roles into social justice, where we have no training and rely on what we feel, rather than rational considerations.
Is reform needed? Sure. Should it come from the government? No. The government already plays a distorting role in healthcare with Medicare and Medicaid, and has contributed heavily to the systematic devaluation of primary care. Considering what the government has done to us thus far, I trust the free market much more than another top down government program.
Just as an aside, I think it highly amusing that the AMA guest posts here do not allow comments. Are they so afraid that others might hold different opinions? Come to think of it, I do understand their reluctance to entertain other opinions. After all, when you’re convinced you’re right, why waste time listening to your constituency?
Tom, I had noticed that as well.
It speaks volumes.
I have voiced this option several times and have yet to get a single rebuttal from ObamaCare supporters. Why not try this on a state by state basis? Maybe choose 2-10 states to try this on. Wait two years and see if life in those states is better or worse and then if worse, work to repeal the new changes (good luck) and if better, go ahead and implement the changes in the rest of the states. I’ve received replies from ObamaCare opponents pointing out that Massachusetts and the Hawaii children’s programs are already examples of failure of govt-controlled medicine. Any reason why it wouldn’t be smarter and safer to implement any new sweeping changes on a limited state-by-state level first? We could argue all day on whether govt controlled healthcare is better or worse, but as rational scientist, why don’t we just experiment partially rather than experiment completely (as would a complete change)?
Anybody who supports a vast, basically secret, probably uncontitutional legislation prepared by a sorry collection of corrupt totalitarians, is a fool.
If everyone was happy, we would all be broke
Why would ACS( surgery) , ACP,AAFP, AMA and others endorse this bill. AMA opposed enacting Medicare strongly. Those bills don’t have Obama’s stamp yet, they will get a defit neutral bill in the end, they have no choice on this. If we go another 10 years or 15 years without change, we’ll really be boiling in a rut. I think people really really need to feel the heat not just know where it will lead us and given tons of money for vested interests, why would they give up anything without a war. Patients have the least influence in this and they have no seat at the table. Congress worries about next election, private insur about their share holders. It took a Herculean effort for medicare to be enacted and with current elecronic age and fear mongering, it will a really heavy lift for this admin. It was not done for 50 years for a reason, IT IS DAMN HARD! We sooo need it and lets be on the right side of history and supportthe efforts.
BTW, I think the only thing that will financially save America and prevent the bankrupting of our country has nothing to do with government vs private insurance. The point is moot. Under current payment models both have proven a morbid failure.
What does matter is how we pay for medical care. To save MedicareAmerica, we will have to
bundle care
Kevin — well-reasoned and courageous coming out with this. You are right that this reform is not perfect, but it’s an improvement. Actually, for all the heat and light surrounding the public plan, the most important elements of the bill are established (and almost being overlooked). Namely, guaranteed issue, community rating, no recissions, and the National Insurance Exchange, in addition to the Employer mandate and the individual mandate.
As a progressive, as a doctor, and as a small-business owner, I’m happy just with that, even if we get no more. I think Obama is right to push for a better deal, if we can get it. But the key reforms appear to be agreed on at this point, and that’s a great accomplishment.
You’re right — the perfect should not be the enemy of the good, and what we have so far is very good indeed.
IVF MD,
The nest reason not to “experiment” with these reforms is because reform is very hard, and we may only get one shot at this. We have the pro-reform party in charge of both houses and the White House, and for the first time in 40 years there is a chance of getting comprehensive reform passed. If we restrict ourselves to tinkering, the likelihood is that in two or four years the political opportunity for national reform will be gone.
I would also argue that there is an urgency contributed by the 50 million uninsured, but that argument is sadly undermined by the fact that many of the reforms may not be in place till 2013.
Finally, there are practical obstacles to regional implementation. Can the federal government mandate (for example) community rating for insurance companies in only part of the country? I dunno; there seem to be equal protection issues there, but I’m no lawyer. More saliently, many of the commissions that are proposed (like IMAC and the OCE) are federal by their very nature. Comparative efficiency can’t be regionalized easily.
Tom is right on. Government can’t really solve the problem because government IS the problem.
The notion that health care is a right is a problem.
The notion that the government has any business providing health care or health insurance is a problem. (I might understand the VA system, but it would probably have worked better just to provide them with insurance and not create a separate system).
People are SO confused and misled on this topic that they just want to cry. “If Obama’s change isn’t right, then what is?” they whine. We can’t just accept the status quo!
The massive obfuscation of these pleas is sickening. It is Medicare and Medicaid that have contributed to the massive explosion in expenses in this country on medical care. The government has introduced massive price inflation into the system (witness medical care costs as a percentage of GDP since the 1960’s when these programs were introduced – changing rapidly from 6% to about 16% of GDP!). It should be clear to everyone that when something is free, or nearly free, for patients, then they want it all. It should be clear to people that if the government is willing to pay big bucks for technology and other medical care, that doctors will provide it and set their prices accordingly. This is simple economics – it is no one’s fault but the fools who put the programs into effect in the first place.
The tremendously tangled, expensive, and despite this, still effective, medical system is a product of massive government intervention. This occurs at the local level, state level, and federal level. Tax laws favor employers providing health benefits, greatly reducing the portability of health insurance and tying people to their jobs. City governments decide which clinic or hospital will open up and for what. EMTALA laws hamstring private hospitals, turning all hospitals into forced welfare programs. Medicare essentially owns the elderly market – and controls nearly every important aspect of how health is delivered to them.
Health insurance companies are massively regulated, such that it is determined what they can charge, when they can change their prices, and what products they must offer. States can put an insurance company out of business at a moment’s notice. Do you think you could do better than these companies under such circumstances?
People who believe in communism (or extreme liberals, we’ll say) don’t realize that all their laws and rules to force people to behave the way they want usually (1) result in a massive slowdown in the system and lead to inferior products and (2) usually don’t guarantee the outcome they originally intended anyway. It is precisely because health care is considered so important to the liberal that he/she has focused on it so much – and because of this, has hampered it so much. (If liberals cared about software engineering to the same degree, then that sector of our economy would also be over-regulated).
So…. it is ironic that people with the mindset that brought about all this regulation in the first place are now complaining that something must be done about the ’status quo’! Instead of recognizing the error of their ways – they want to introduce even more government control into the system.
The real answer is: dismantle all the taxation laws and controls that are currently hampering medicine. It isn’t sexy, I know, but undoing the harmful laws and regulations is the ONLY answer that will actually work.
Deregulate everything, let everybody figure out ways to medically treat themselves according to their own scale of valuations.
Jack Benny was right:
“Your money or your life?”
“………………………………………..Well?”
“…………..I’m thinking, I’m thinking.”
Kevin, You sir are a sell out. Don’t let your media attention go to your head. And no we should not all collectively agree to a poor plan. Our country is bankrupt. We have a problem saying no to our country. Public insurance is nothing more than perpetuating our nations spending problems. Medicine happens to be the front line issue of spending, and you are advocating we continue to burn the benjamins. This is ludicrous.
Nothing infuriates me more than acting like not implementing the SGR cuts is some kind of victory. Anyone who thought Congress was going to cut Medicare payments 20% this year if the AMA did nothing is an idiot. SGR cuts are a hollow threat and claiming that getting them removed is the backbone of a victory demonstrates just how little in this bill is good for doctors (i.e., nothing).
We’ve decided we need “reform” so let’s title anything we need as “reform” and thus that means it’s good! Because we have a “crisis”. Physicians and taxpayers shouldn’t bother asking what’s on the menu. It’s you.
HaHaHaHaHaHaHaHaHaHa!
Don’t just do nothing, stand there…
Let’s see, 100 trillion, as is, with current entitlements, in the the next generation. Bankrupt.
4.3 Trillion dollars into money hole incinerator. Check.
Squeamish doctors show typical backbone, jump at chance for short term ability to take one lick at ice cream flavor of Retribution. Yum.
microcosm of USA, see health care.
Let me end with my all-time favorite newspaper article, paraphrased:
People Stay in Line at DMV After Man Defecates on Floor.
from Charleston.net (Associated Press). Saturday, July 21
SPARTANBURG – Long lines at the Division of Motor Vehicles and no on-site janitor left a man’s feces sitting on the floor for two hours when the customer had a medical problem in the waiting room.
David Burgis, the division’s deputy director, said no janitor is at the Fairforest Road office here to handle emergencies.
The cleaning service is contracted through a service that cleans the building once a day, Burgis said.
The office manager asked the man’s daughter to take the man to the bathroom, but she refused. The manager called the cleaning service, but workers could not respond immediately.
Brenda Hatcher, who was in line, said some customers left, but most stayed because they didn’t want to give up their place in line.
“There was never any thought to close the office because there were so many people in line,” Burgis said.
Workers changed the line configuration and taped off a chair so customers could avoid the fecal matter the man spread over several areas of the room.
The man did get his driver’s license renewed and left about an hour after the accident.
Kevin, I’m with you. If history repeats itself it will be another 20 years before a chance to make significant reforms comes around again and that’s just way too long for millions of people getting lousy care or no care in our current system. I look at this as a patient: right now if I got fed up with my multispecialty group and wanted to put up my own shingle, I would not be able to get health insurance for my husband at any price. I have tons of patients in a similar boat, one stroke of bad luck (a divorce or loss of a job)away from having to “go bare” and risk personal bankruptcy. This unfettered free market utopia that docs want to have just doesn’t pan out in the real world of people scratching to get by.
This isn’t perfect reform but it sets the stage to make some real changes to how care is paid for, which will change how it is delivered, which will help raise up primary care. Think anyone is going to give a hoot about primary care if the incentives don’t change?
And not having to go to Washington every year to fight off the SGR cuts will be a real time-saver…..we can all stay home and practice medicine for a change!
can we pass a law that people have to have health insurance before they can get cable tv? an ipod? sure people get into some trouble due to unanticipated health care expenditures, but it is not at all clear that they are saving appropriately in the first place. if you are in your 20s and in good health and choose not to be insured, then you should not be counted in the 47 million uninsured.
this plan is a terrible plan. they haven’t even finished writing it yet. rushing because it is our ‘only chance for 20 years’ is a terrible reason to push something this important through. how about other platitudes-’things can always get worse’ or ‘the more things change, the more they stay the same’?
“And not having to go to Washington every year to fight off the SGR cuts will be a real time-saver…..we can all stay home and practice medicine for a change!”
I’m sorry, are you saying that when government gets MORE involved in healthcare there will be less lobbying necessary? If so, this kind of naivete will not serve you well in the coming healthcare regime.
As the largest physician group in the US, we see our position at the center of the health reform debate as an honor and a serious responsibility. 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. As the bill moves through the legislative process, the AMA will be at the table to improve the final legislation, including pushing for liability reform.
HR3200 includes many key provisions for effective, comprehensive health reform. It establishes a health insurance exchange that would provide a choice of plans to the uninsured, self-insured and small business employees, with voluntary physician participation. Reform of the broken Medicare physician payment formula is needed and the bill erases the SGR debt. It also includes an end to insurance coverage denials based on pre-existing conditions and adds funding for primary care services, without reductions on specialty care.
No other physician group in the nation allows all physicians a voice in the future of medicine in our country. We urge all physicians to join us in our quest to pass health reform this year that better serves patients and empowers physicians to deliver the highest quality care.
J. James Rohack, M.D.
President, American Medical Association
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