Thursday, June 11, 2009
Health The American Medical Association Opposes Real Health Care Reform
Posted by Eli Sanders on Thu, Jun 11, 2009 at 10:00 AM
Yesterday I noted that Seattle Congressman Jim McDermott, and his staff, believe that "if there isn’t a public option, you’re not going to have real health care reform.” Most serious people in the health care debate—or, at least, most serious people on the left—believe this. Why?
Here's why, via Ezra Klein:
The private insurance market is a mess. It's supposed to cover the sick and instead competes to insure the well. It employs platoons of adjusters whose sole job is to get out of paying for needed health care services that members thought were covered.Moreover, public insurance is simply more efficient. Medicare holds costs down better than private health insurance. The substantially public systems employed by every other industrialized nation cost less and cover more than the American model. So the question became how to marry the policy need for public insurance with the political need to preserve the status quo.
Enter the public insurance option. It doesn't replace the insurance individuals already rely on. But it provides an alternative. It lets them make the decision. It's the health care equivalent of being pro-choice. And it thus serves two purposes. The first is to act as a public insurer. To use market share to bargain down the prices of services, much as Medicare does. To lower administrative costs. To operate outside the need for profit, and quarterly results. The Commonwealth Fund estimated that this would result in savings of 20%-30% over traditional private insurance.
The second is to apply competitive pressure to the rest of the insurance industry. If the public plan is ruthlessly lowering its administrative costs and garnering a reputation for decent, good-faith service, it will take market share from the private insurers. The private insurers will have to respond in kind to retain their customers. If they fail to adapt, the system could become something resembling a single-payer structure.
Now comes the news that the American Medical Association—which Klein points out has "opposed all public plans proposed by all presidents in all contexts"—will not support health care reform that involves a public plan, and has told Congress as much in the following language:
The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.
Which, again returning to Klein, is what the AMA has been saying forever.
The AMA represents the interests — which it tends to define as the profits — of doctors. That gives it a slightly different perspective on the American health-care system. Judged as a health-care system, it's pretty bad, primarily because it's so expensive. But judged as a mechanism for funneling profits toward various actors in the medical industry, it's pretty good, primarily because it's so expensive. Things that would make it cheaper — like a public plan — will inevitably cut into the profits of doctors. And the AMA doesn't want that.
Obama's going to be addressing the AMA on Monday in Chicago. Will he take them on the way he took on the auto-makers in Detroit in a speech during his presidential campaign? The way he took on the Muslims and Jews of the Middle East on his recent trip to Cairo, telling them to speak honestly about the truth of their conflict and the limited possible solutions? The way he took on unhelpful exploiters of America's racial tensions in his famous speech in Philadelphia?
We'll see.
Until then, please enjoy, once again via Klein, a pre-presidential Ronald Reagan telling Americans in 1961 why health care reform is a sneaky form of socialism. Guess who paid him to do this? The AMA.
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2
Join the Facebook group and sign MoveOn.org's petition in support of the Public Option. http://tinyurl.com/my33gl and http://pol.moveon.org/popetition/
The Dems caving to the AMA and health insurance companies should be kicked out of congress.
The Dems caving to the AMA and health insurance companies should be kicked out of congress.
3
Quite simply, the AMA doesn't oppose health care reform, the AMA opposes doctors taking a pay cut.
4
The private system in place is certainly messy and needs to change, but if you want to see a real mess, go to Britain, France, or Canada. People in those countries are generally not nearly as enamored with their public plans as McDermott is. Will he be switching off of the US House plan on to the public plan if it comes to pass? I doubt it very much.
Anyone who thinks solving the cost problem in this country is as simple as dropping in a public plan is either an idiot or a liar...or in McDermott's case, both.
Anyone who thinks solving the cost problem in this country is as simple as dropping in a public plan is either an idiot or a liar...or in McDermott's case, both.
5
It's complicated. If you come out of medical school with $250,000 in loan debt, of course you're going to want/need a high-paying gig to cover that.
Let's do 2 things: fund education at all levels (better students and teachers at all levels; and no crippling loan debt for those who attend college/graduate school, so far less pressure for sky-high pay to get out of debt) and go single-payer for healthcare.
Hell, pitch single-payer to Republicans as a potential union-busting ploy--if everyone is covered, no union bargaining on that point. (I know that wouldn't solve all grievances, and hence not kill unionizing, but it might be enough to convince people.)
Let's do 2 things: fund education at all levels (better students and teachers at all levels; and no crippling loan debt for those who attend college/graduate school, so far less pressure for sky-high pay to get out of debt) and go single-payer for healthcare.
Hell, pitch single-payer to Republicans as a potential union-busting ploy--if everyone is covered, no union bargaining on that point. (I know that wouldn't solve all grievances, and hence not kill unionizing, but it might be enough to convince people.)
6
@3 is correct.
Many doctors get a lot of their money from firms and suppliers they have procedures done at, owning shares in various such things.
Insist on single-payer health care as a default option that all American citizens get and don't take no for an answer - but do it NOW cause they literally are deciding it this week - in a couple of weeks it will all be sewn up and they'll put on a show to pretend there's a discussion then, but the discussion and bargaining is NOW.
Many doctors get a lot of their money from firms and suppliers they have procedures done at, owning shares in various such things.
Insist on single-payer health care as a default option that all American citizens get and don't take no for an answer - but do it NOW cause they literally are deciding it this week - in a couple of weeks it will all be sewn up and they'll put on a show to pretend there's a discussion then, but the discussion and bargaining is NOW.
7
It gets even worse when you realize that while most Americans support single payer health care, most liberal politicians don't:
http://www.inthesetimes.com/article/4459…
http://www.inthesetimes.com/article/4459…
8
@5 I'll have about that debt for vet med school, and vets don't make a lot of money. We don't have the crippling liability insurance, but still, human doctors shouldn't have such a focus on money. You know things are fubar'd when general practitioners are in rapid decline, because they don't make enough money.
9
#4 Tell that to the old people and homeless that get regularly dumped on skid row. We pay twice as much as (per GDP) as any other Industrialized nation and have the 37th best health care. I would call that a disaster already.
10
I guess that's why when I watched the Gipper launch his campaign in Philadelphia Mississippi talking all that racist jazz about state's rights and I saw this film at a fundraising party, I knew he would always be a total bastard. The Iran-Contra affair and the bombing at La Penca sealed the deal for me.
11
Why "single payer"? Why not "Medicare for All?" Senior citizens love and trust Medicare. This seems to be one of those no-brainers that the Democrats just can't figure out. Why do we have "socialized" medicine if you're 65 and older but not if you're under 65 (when costs are much lower)? Why does the government get the hard cases while the private insurers get to make billions off the easy cases?
12
@4,
And yet none of those people would trade their system for ours.
@5,
I'm pretty sure that countries with single payer already institute that. If you guarantee health care to everyone, you're going to need a lot of doctors, making it necessary to provide scholarships to medical school and recruit qualified candidates from other countries.
And yet none of those people would trade their system for ours.
@5,
I'm pretty sure that countries with single payer already institute that. If you guarantee health care to everyone, you're going to need a lot of doctors, making it necessary to provide scholarships to medical school and recruit qualified candidates from other countries.
13
@4 So what's you're great alternative? It amazes me how people like yourself and the AMA talk of dire consequences (while glossing over the dire reality WE ALREADY FACE) yet you have no ingenious alternative to take it's place... maybe because the only options are some level of government regulation, or stick with the current system. I for one welcome a change from the horrible situation we're in now.
14
@11,
Are you kidding? That makes sense!!! This is America, we don't need no stinkin' common sense.
Are you kidding? That makes sense!!! This is America, we don't need no stinkin' common sense.
16
To be redundant, @4), check your speaking points, they are wrong.
None of those countries would trade what they have for what we have. I used to travel to Canada for work and I'd regail my international co-workers with stories of our health care system, they were always shocked. One offered to marry me just to get me out of this deathtrap.
Our system is broken, and there's not even really room to argue it. 60 people die a day from lack of health care. In Canada, on average, people may wait a few days longer to see a doctor for non-urgent care.
None of those countries would trade what they have for what we have. I used to travel to Canada for work and I'd regail my international co-workers with stories of our health care system, they were always shocked. One offered to marry me just to get me out of this deathtrap.
Our system is broken, and there's not even really room to argue it. 60 people die a day from lack of health care. In Canada, on average, people may wait a few days longer to see a doctor for non-urgent care.
17
Fuuuuuuuck the AMA. They perpetuate doctor shortages and a broken healthcare system because those things keep doctor salaries high.
I'm a pre-med student, and I'd happily take a huge cut in my projected pay in order to participate in a functional system. This country would be better off if physicians made less money, anyway. Perhaps more people would go into medicine for the right reasons.
Again: fuck the AMA.
I'm a pre-med student, and I'd happily take a huge cut in my projected pay in order to participate in a functional system. This country would be better off if physicians made less money, anyway. Perhaps more people would go into medicine for the right reasons.
Again: fuck the AMA.
18
Yet there are so many doctors I have encountered who would welcome a public alternative/single-payer system because they wouldn't have to spend so much time fighting the insurance companies to pay up or cover a course of treatment for their patients. They could use that time to do what they wanted to do in the first place: seeing and treating patients.
19
I've known a number of doctors who say that they don't belong to the AMA or the APA for that matter because they recognize that those organizations are corrupt. It's time people realized that AMA membership is not a requirement of being a doctor and that the AMA doesn't speak for all MDs.
20
@11 - because Medicare is basically Socialized Medicine, more like the UK model. Single payer just means all providers have to submit a standard form using standard codes to a central clearing house for approval, but it permits for-profit health care plans and clinics to continue to function provided they meet certain levels of basic services for the default national plan. E.g. hospitals and urgent care clinics can't turn you away.
Single payer can mean socialized medicine, but it could also be more like Sweden or France or Germany, none of which have socialized medicine.
Single payer can mean socialized medicine, but it could also be more like Sweden or France or Germany, none of which have socialized medicine.
21
The problem we have with the mandatory health insurance here in Massachusetts is that doctors don't accept it. If you don't create a single payer system then nothing changes.
22
1. @4 ha ha telling lies again? Not one of those nations has elected politicans who propose to do away with their single payer socialized communistic pinko health care systems. This is the constant lie we are subjected to, like the constant liemyth that our health care system is the best in the world -- easily disproven by facts on longevity etc. -- the constant lie that somehow it makes sense to pay TWICE AS MUCH as the socialized nations -- the opposition to total reform is simply a bunch of lies.
2. The current proposals are going to include a universality requirement a/k/a mandates -- once again ITYS.
3. Long term prevention is the key. Our system isn't set up for this so we don't do it. Similarly for cost controls -- socialized has to measure and budget total national health costs and in our system we don't so we can't control it.
4. Very odd that Obama would go to Wisconsin. I'd like to see him go where we need to persuade a blue dog democratic senator to get on board with the public option -- you know, put 100,000 screaming Obamaphiles in stadium and have the implicit message be: get on board or you're out of office dude. The key to this whole battle is just about 10 blue dog democratic senators....if Obama won't lead the charge on them, perhaps some enterprising alt media news source reporter can tell us who they are. You know, explaining the theory of the reforms is great and stuff but you know, we gotta make it happen, too.
Mmmm?
2. The current proposals are going to include a universality requirement a/k/a mandates -- once again ITYS.
3. Long term prevention is the key. Our system isn't set up for this so we don't do it. Similarly for cost controls -- socialized has to measure and budget total national health costs and in our system we don't so we can't control it.
4. Very odd that Obama would go to Wisconsin. I'd like to see him go where we need to persuade a blue dog democratic senator to get on board with the public option -- you know, put 100,000 screaming Obamaphiles in stadium and have the implicit message be: get on board or you're out of office dude. The key to this whole battle is just about 10 blue dog democratic senators....if Obama won't lead the charge on them, perhaps some enterprising alt media news source reporter can tell us who they are. You know, explaining the theory of the reforms is great and stuff but you know, we gotta make it happen, too.
Mmmm?
23
Funny how conservatives are so afraid of competition in health care. If private companies can do everything better than the government, than there shouldn't be any threat them by a public option.
So I call BULLSHIT! Conservatives know the government can do it better and at lower costs. So there whole world view is threatened by a public option.
That's why they are so kamikaze about this.
So I call BULLSHIT! Conservatives know the government can do it better and at lower costs. So there whole world view is threatened by a public option.
That's why they are so kamikaze about this.
24
The AMA also support decriminalizing marijuana, and nobody in the government seems to be paying that advice any attention.
25
The AMA screws the public by lobbying state legislatures to restrict what nurse practitioners can do. NPs want to treat the people (for less money and focusing on prevention) General Practitioners *used* to see, but the AMA doesn't want nurses "taking" patients away from docs. The fact that the various state nursing organizations have to battle with the local AMAs tells you a lot about where AMA's heads at.
26
@4 And of course, the major difference is that folks in those countries have some sort of avenue to improve their current systems, as they are administered by a democratic government.
The US does not have that option. The system is controlled by BigPharma & BigInsurance - the AMA is just along for the ride. It is a monumental effort to make any change to the current system.
Think about it: what chance to you have to get BlueCross to change their policy and include procedure X as a covered benefit? None whatsoever. In a government administered program, you could contact your Rep/Sen, form a "special interest group" to apply political pressure, or start a referendum to get that procedure covered.
It's a pretty radical idea, but sometimes a government of, by & for the people can actually *respond* to the people.
The US does not have that option. The system is controlled by BigPharma & BigInsurance - the AMA is just along for the ride. It is a monumental effort to make any change to the current system.
Think about it: what chance to you have to get BlueCross to change their policy and include procedure X as a covered benefit? None whatsoever. In a government administered program, you could contact your Rep/Sen, form a "special interest group" to apply political pressure, or start a referendum to get that procedure covered.
It's a pretty radical idea, but sometimes a government of, by & for the people can actually *respond* to the people.
27
@18 - Yes... I've seen the same thing with teachers who are willing to take a pay cut (off their already low salaries) to work in a school that runs well, so they can spend more time doing what they actually like to do, teaching kids. It makes sense -- I think many of us would be open to being paid a little less for a job we found more enjoyable.
It's pretty clear that many doctors are frustrated with the current system because of their interactions with the insurance companies, and because of the need to take on more and more patients (and therefore, they spend less quality time with each patient). My old GP in Chicago is planning to switch to concierge medicine because she was frustrated by the number of patients she was required to take on and felt that her care was suffering.
Anyways, I also agree with the point about doctor debt. The government already has programs that forgive a portion of your loans if you work in an under-served area for a number of years. It shouldn't be too hard to expand that program...
It's pretty clear that many doctors are frustrated with the current system because of their interactions with the insurance companies, and because of the need to take on more and more patients (and therefore, they spend less quality time with each patient). My old GP in Chicago is planning to switch to concierge medicine because she was frustrated by the number of patients she was required to take on and felt that her care was suffering.
Anyways, I also agree with the point about doctor debt. The government already has programs that forgive a portion of your loans if you work in an under-served area for a number of years. It shouldn't be too hard to expand that program...
28
Love that argument: We can't let public insurance compete with private insurance, because the inevitable efficiencies-of-cost and improvements in service would drive people away from the greedy private for-profits and either put them out of business, or else force them to lower their obscene profit margins in order to compete successfully!
How unAmerkin!
How unAmerkin!
30
This is one of the first posts I've seen in Slog's healthcare debate that actually gets at the cost issue which is the key friction point in this entire mess.
The post notes that Medicare does a good job keeping costs down. Do you know how Medicare keeps costs down? They decide what rates are appropriate for various procedures and that's what they pay. Doctors can, of course, opt out which makes finding a doctor or simply staying with the one you have more and more difficult.
And doctors say that the reimbursements they receive from Medicare increasingly don't cover their costs. Do you know how they bridge that gap? The negotiate HIGHER rates with private insurance carriers.
It isn't surprising that the AMA is opposing the idea of reform. Under a single policy, like Medicare, they're likely to make A LOT less than they do now and they're going to fight that tooth and nail. Private insurance is the only money train they have since most of us couldn't afford to pay cash at the rates they want.
So, the challenge here is not getting a single payer policy passed. It's enacting sweeping changes in a medical industrial complex that will mean lower payments and smaller paychecks in exchange for a cost effective and sustainable system. Guess what the AMA prefers?
Good luck with the changes. I hope it can happen but the power in this case does not lie with the patient, it lies with the doctors and insurers who can afford to pay to play in Washington.
The post notes that Medicare does a good job keeping costs down. Do you know how Medicare keeps costs down? They decide what rates are appropriate for various procedures and that's what they pay. Doctors can, of course, opt out which makes finding a doctor or simply staying with the one you have more and more difficult.
And doctors say that the reimbursements they receive from Medicare increasingly don't cover their costs. Do you know how they bridge that gap? The negotiate HIGHER rates with private insurance carriers.
It isn't surprising that the AMA is opposing the idea of reform. Under a single policy, like Medicare, they're likely to make A LOT less than they do now and they're going to fight that tooth and nail. Private insurance is the only money train they have since most of us couldn't afford to pay cash at the rates they want.
So, the challenge here is not getting a single payer policy passed. It's enacting sweeping changes in a medical industrial complex that will mean lower payments and smaller paychecks in exchange for a cost effective and sustainable system. Guess what the AMA prefers?
Good luck with the changes. I hope it can happen but the power in this case does not lie with the patient, it lies with the doctors and insurers who can afford to pay to play in Washington.
31
AMA also has a bullshit racket on CPT codes, to which they hold the copyright but whose use is also mandated by CMS and HIPAA as Level 1 of HCPCS.
My company makes medical coding reference software, and not only do we pay the AMA for the CPT data in a shitty useless format that required development time to import, we have to pay them huge royalties for any customer with access to the data or access to the associated fees and relative value units. Then new data is out every year that means a new royalty. Wikipedia claims they're just getting in the way of doctors charging the correct amounts for their procedures, and I'm inclined to agree.
Imagine if Turbotax came up with some new fancy tax forms, and held a copyright on them, then the IRS required that everyone use those tax forms. Except, of course, Turbotax holds the copyright, so everyone has to pay for Turbotax to submit their taxes. It's pure fucking bullshit.
The amount of development time we've put into calculating royalties for the AMA is staggering, and they're also extremely anal about their copyright notices appearing on any page or product that even mentions CPT let alone provides any actual data.
CPT © 2009 American Medical Association. All rights reserved.
My company makes medical coding reference software, and not only do we pay the AMA for the CPT data in a shitty useless format that required development time to import, we have to pay them huge royalties for any customer with access to the data or access to the associated fees and relative value units. Then new data is out every year that means a new royalty. Wikipedia claims they're just getting in the way of doctors charging the correct amounts for their procedures, and I'm inclined to agree.
Imagine if Turbotax came up with some new fancy tax forms, and held a copyright on them, then the IRS required that everyone use those tax forms. Except, of course, Turbotax holds the copyright, so everyone has to pay for Turbotax to submit their taxes. It's pure fucking bullshit.
The amount of development time we've put into calculating royalties for the AMA is staggering, and they're also extremely anal about their copyright notices appearing on any page or product that even mentions CPT let alone provides any actual data.
CPT © 2009 American Medical Association. All rights reserved.
32
@30;
I'm on Medicare and I have had NO problem finding a doctor. In fact, every one of the doctors who took my old insurance accept Medicare - and so do a few other [better] doctors that didn't accept my old insurance so I had to pay them out-of-pocket.
My care under Medicare is just as good, if not better than, my old employer-paid insurance - and my employer used their generous healthcare policy as a recruiting tool!
I'm on Medicare and I have had NO problem finding a doctor. In fact, every one of the doctors who took my old insurance accept Medicare - and so do a few other [better] doctors that didn't accept my old insurance so I had to pay them out-of-pocket.
My care under Medicare is just as good, if not better than, my old employer-paid insurance - and my employer used their generous healthcare policy as a recruiting tool!
33
@27
It WILL be important for those loan forgiveness programs to be expanded if doctors are going to make less money, yeah. It would also help if the AMA would stop trying to limit the number of available slots in medical schools, so that it could be cheaper to get that education (did I already say "fuck the AMA"? I think I did).
I'm not sure that the average person has really stopped to consider how huge the burden of student loan debt (not to mention malpractice insurance) really is. I'm going to be paying the equivalent of a mortgage payment to the loan people for several years after I get my first real (aka post-residency) gig. The current forgiveness programs would only cover a fraction of what I will owe. I'd love to work at a community health clinic or something along those lines, but realistically, I won't be able to afford to start my career that way, unless the government decides to help me get out of debt. If my salary is less under a publicly funded system (which I welcome), that'll be even more true.
It WILL be important for those loan forgiveness programs to be expanded if doctors are going to make less money, yeah. It would also help if the AMA would stop trying to limit the number of available slots in medical schools, so that it could be cheaper to get that education (did I already say "fuck the AMA"? I think I did).
I'm not sure that the average person has really stopped to consider how huge the burden of student loan debt (not to mention malpractice insurance) really is. I'm going to be paying the equivalent of a mortgage payment to the loan people for several years after I get my first real (aka post-residency) gig. The current forgiveness programs would only cover a fraction of what I will owe. I'd love to work at a community health clinic or something along those lines, but realistically, I won't be able to afford to start my career that way, unless the government decides to help me get out of debt. If my salary is less under a publicly funded system (which I welcome), that'll be even more true.
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