In President Obama’s speech to the American Medical Association today he stood strong on all the elements of health care reform that he’s championed since the election. And in front of a tepid audience that has yet to drink the Obama Kool-Aid, the President sought to divide and conquer the larger population of physicians—reaching out to those who reject the long-term fear tactics that raise the twin specters of “socialized medicine” and “rationed care.” The AMA establishment has used these scary phrases to oppose past efforts to reform health care and recently, they’ve used them to warn against a public option for insurance.
Today, Obama reminded physicians that “you entered this profession to be healers,” not “bean counters.”
As has become increasingly clear since the AMA’s position became public, they do not speak for all doctors. First of all, the notion that the AMA represents all doctors, or even a majority, is just plain wrong. With 225,000 members, AMA membership represents just 25% of practicing U.S. physicians. They may have the loudest voice right now–and by spending $11 million on lobbying efforts last year, the dollars to make their voice heard by legislators—but others are quickly gaining ground in the fight over the heart and soul of reform.
There are some 900,000-plus practicing physicians in the U.S.; 40.4% practice primary care (general internists, pediatricians, ob/gyn and family practice) and 59.4% are considered specialists. They belong to numerous professional societies. Some support a single-payer option; others favor a quasi-public plan; while still others are opposed to a public option for health insurance.
Some of these groups have not yet made their preference public, but in a statement released today, a coalition of doctor organizations claiming to represent 215,000 physicians and “physicians-in-training” pledged their support for Obama’s public health insurance option. Members of this coalition include The American Academy of Family Physicians, The American Medical Student Association and the National Physician’s Alliance, to name just a few.
In their statement the coalition says:
“As doctors who work on the front lines of our fractured healthcare system, we are convinced by firsthand experience that our patients desperately need health care reform that protects them from falling through the cracks. This means reform that creates the freedom of choice to keep their current plan, choose another private plan, or have the choice of a carefully designed quality, affordable public health insurance plan.”
Dr. Chris McCoy, the policy chair for the National Physician’s Alliance, speaks his mind about the AMA’s response to the Senate Finance Committee proposal for health care reform that includes using the Medicare program as the model for a public insurance plan. In a post entitled, “Dear AMA: I Quit!” McCoy writes:
“In reading the response, I was frustrated and disheartened by the fact that you couldn't get through the second paragraph before bringing up the issue of physician reimbursement. This merely highlights how the AMA represents a physician-centered and self-interested perspective rather than honoring the altruistic nature of my profession.”
Other signs that a sizable portion of doctors do not oppose a truly public plan:
In the April 1, 2008 issue of Annals of Internal Medicine, Dr. Aaron Carroll, director of Indiana University’s Center for Health Policy and Professionalism Research found that 59 percent of 2,000 doctors surveyed support government legislation to establish national health insurance while only 32 percent oppose it.
The fight over a public plan option will heat up as health reform legislation gets closer to a Senate vote. In some ways, the battle between physicians mirrors the nature of the debate in Congress and throughout the country. There are essentially three divisions forming:
–A contingent that, like Obama, supports expanding Medicare to all through a public insurance option that will compete with private plans.
–A contingent, like the AMA and a few other physician groups (including the American College of Physicians) that now say they support a non-Medicare version of a public plan similar to one outlined recently by Senator Charles Schumer that does not use Medicare payment rates and will "comply with the rules and standards of private industry."
–A contingent, led by the GOP and folks like Senator Mitch McConnell, the Senate Minority leader,
along with health insurer industry groups that opposes any public plan option.
Where do Americans stand on this issue? It may be that physicians have lost some of their sway over the general public and that the “scare tactics” used by some of the AMA’s leadership are losing their bite. Details of a poll on the public’s view of health reform, released today from the Employee Benefits Research Institute (self-described as an independent, nonprofit, and nonpartisan organization) can be found on Daily Kos. The poll includes these encouraging findings on the public plan option: 53% of those polled strongly support a public plan option in health reform, 30% somewhat support this option and only 9% strongly oppose the option.
The weeks ahead will provide much insight into this issue as the various groups hammer out the details of reform. But in the meantime, what is your view of a public option for health insurance?
Playing the devils advocate, what could our society do if providers refused to go along with the payment reforms and care provision reforms that are being advocated by reformers. What if providers continue to embrace lack of strong guidelines and fee for service medical care especially in a consumer directed healthcare model with HSA money available or in a boutique type model. What could society do??
I ask this not out of thin air but with a real example of societal failure in mind. I spent most of my life in dental public health, and ever since Medicaid passed in the mid sixties, kids on Medicaid have been mostly unable to get access to private dentists’ office by design. Society has never done anything to change that. Could that happen now to the broader health reform actions, and what could society do to really stop it??
unclear to me why existence of public plan is an issue. the biggest plan in America today is a public plan — Medicare — and it is threatened by bankruptcy because of rapidly growing costs –notwithstanding the fact that it can dictate prices. Is there any reason to assume that a public plan for younger folks would do better?
Jim–
Thanks for your comment.
The president is suggesting putting MedPac in charge of Medicare and giving it a chance to implement its recommendations with little interference from Contress (i.e. lobbyists. )
This would really cut Medicare’s costs, while simultaneously lifting quality.
Medicare is in danger of runnign out of moeny beause of all the unncessary overtreatment that MedPac writes about.
A public plan based on a reformed Medicare woudl be much less expensive–and provide better care.
This is what Obama talked about today in his speech to the AMA
While reform is certainly necessary, creating a system that fails to financially incentivize physicians will only create more problems. To receive their degrees, doctors endure a very malignant process (med school and residency) with little graification, only to carry a hefty six-figure debt burden upon completion. Not only are they saddled with debt, but they also delay several years of income, which, if invested wisely, could have grown to six or even seven figures by retimrent age. This burden and the strong incentive to earn as much as possible is why there’s such a steep decline in those entering primary care, while more and more gravitate towards higher-paying specialites. If we want to pay physicians less, then we must realign their incentives and pay them for keeping people well. We must also address the cost of med school. To do this, we would need to restructure our educational system.
Furthermore, to reduce unnecessary tests, which greatly drive up costs, doctors must feel free to stop practicing “defensive medicine,” which is driven by the fear of litigation. This would require restructuring our legal system.
Finally, to reduce costs the consumer must take responsibility for his or her health. The largest killers, which cost us the most, are largely lifestyle diseases – heart disease, stroke, cancer and COPD. To get Americans to embrace healthy lifestyles, we must restucture our consumer culture.
Until Americans adopt healthy lifestyles and take part in assuming responsibility for their healthcare costs, no measures will solve the problem.
The healthcare issue goes far beyond medical costs. Until our leaders (and we the people) acknowledge this, we will only contine to treat the symptoms, and never truly treat the cause.
Naomi,
I support Obama and an expanded “Medicare E” public program competing with private insurers…coupled with everything associated that Obama & Maggie have been talking about (best practices, quality improvement…etc)
Hank: We don’t have to restructure our legal system to improve healthcare quality. Our legal system (relating to medical malpractice) has already undergone “restructing” (caps on damage awards) and that has not improved quality…it’s resulted in more victims and injustice.
Healthier lifestyles reducing healthcare costs has been written about here by Maggie time and again. I smoke, I’m not the one running up your healthcare costs.
Frankly I am amazed at how the Republicans ripped the UAW (and rightly so in some regards) for the destruction of the American auto industry yet there is not a single Republican criticism of the AMA which in many ways acts like a union and has in many ways been a consistent roadblock to any reform efforts to control costs and played a significant part in healthcare costs rising in this country?
The “fallacy of defensive medicine” is being brought up again in the health care reform debate.
Shouldn’t we be wanting a system that lessens the prevalence of medical errors, provides an avenue for compensation without undue reward for those who are injured by medical negligence and place the ultimate cost of such compensation on those whose conduct is the most reckless?
The real malpractice crisis is the fraction of doctors who commit most of the negligence and medical errors. Just 5.3 percent of doctors are responsible for 56 percent of medical malpractice payouts nationally, according to the NPDB.
The only people who benefit by medical malpractice reform are the doctors and hospitals who commit the malpractice in the first place. Why should innocent victim’s rights to seek compensation be limited? That just rewards the wrongdoers. To help eliminate medical malpractice, state Medical boards have to do a better job of weeding out the bad doctors who cause most of the harm.
And the reason most physicians and nurses do not speak up against these incompetent physicians is that there is a very real and efficient retaliation system in place in most medical institutions. It’s a falacy to believe that physicians are empowered to “police themselves.” This intimidation is getting worse and threatens any real improvement in patient safety issues.
Most caregivers risk their jobs, priveleges, lawsuits, malpractice charges, increased premiums, and defamation, when they “speak up.” The only connection most physicians see between identifying substandard care and effect is malpractice premiums go up and payouts get bigger, but the practices continue unabated.
There are extremely ethical and wonderful doctors who are giving up their practices because premiums are so high and they have seen such bad care coming along they are not willing to lower their standards any more and decide to get out. General consensus is that the public doesn’t care. I prefer to think it is they don’t know, but maybe they don’t care.
A study done by the U.S. Department of Justice confirmed that the much-hyped medical malpractice crisis simply doesn’t exist. The total cost of all medical malpractice insurance is less than one percent of the total health care bill. Most cases brought against doctors are dismissed and the ones that go to trial are generally won by the doctors.
Again, the bottom line is the only persons who benefit by medical malpractice reform are the doctors and hospitals who commit the malpractice in the first place.
Doctors and Nurses across America should begin to organize “Public Option Cinics” Invite all those without Insurance to receive back to school exams and also voice their support of a Strong Public Option.
The medical services are necessary for all people regardless of their age. It is always appropriate to a medical check in which we can realize our health and best of all, prevention
I’m very interested in it. Thanks for a lot. I wish see the other again from you.