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.

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This morning, Dr. Atul Gawande spoke to student graduating from the University of Chicago’s Pritzker School of Medicine, calling on them to join in the “battle for the soul of medicine.”  Unlike many who say “we  must do something,” he offered some very specific examples of how doctors can “resist the tendency to see patients as a revenue stream.”

      Below, excerpts from his address:

. . . I want to tell you the story of a friend I lost to lung cancer this year. Jerry Sternin was a professor of nutrition at Tufts University, and with his wife, Monique, he’d spent much of his career trying to reduce hunger and starvation in the world. He was for awhile the director of a Save the Children program to reduce malnutrition in poor Vietnamese villages. The usual methods involved bringing in outside experts to analyze the situation followed by food and agriculture techniques from elsewhere.

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Health Wonk Review, a round-up of some of the very best health-care blogging, was posted today on Managed Care Matters. There, host Joe Paduda has done an outstanding job of  pointing to the diversity of opinion in the blogosphere. He opens with a letter from Senator  Dorgan, Chairman of the Senate Democratic Policy Committee (DPC), addressed to HWR’s readers. (The Review has been getting attention from policy-makers in Washington.)
Click here and enjoy.

The American Medical Association has announced
its opposition to a public-sector health plan that would compete with private
insurers. Why? Because the AMA fears that Medicare E (for everyone) might not
pay some specialists as handsomely as private insurers do now. 

Why do private
insurers pay more? Because they can pass the cost along to you and I in the
form of higher premiums.  Medicare E has
no one to pass costs on to—except taxpayers. And taxpayers will already be helping
 to subsidize those who cannot afford
insurance.

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There’s a battle brewing over bisphenol A (BPA)—an ubiquitous chemical compound that is found in baby bottles, beverage containers, and in the lining of canned foods, as well as in hundreds of other consumer products. It’s a battle that might offer the first real test of the Food and Drug Administration’s new pledge to “put science first” when making decisions about potentially harmful substances. It’s also a battle that highlights serious deficiencies in the nation’s ability to control toxic substances in the environment.

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Today’s New York Times tries to tell a story at the very center of what is shaping up as a stormy debate over  just how much waste there is in our healthcare system.   But while striving to be even-handed,  the Times quotes both informed and uninformed sources—sometimes taking informed sources out of context—and in the process, makes hash of the facts.

The Times begins by reporting that the New Yorker article that I wrote about last week “has become required reading in the White House.” This story, by Dr. Atul Gawande, describes pricey and potentially harmful overtreatment of patients in McAllen, Texas, where Medicare spends more, per capita, than in any other town in the country.  The data behind the story comes from more than two decades of Dartmouth research showing “widespread and unwarranted variations” in how much care very similar patients receive in different parts of the country.  

The Times explains that the Dartmouth research focuses a “problem that intrigues the President very much . . . the huge geographic variations in Medicare spending per beneficiary.” What’s shocking is that “the higher spending does not produce better results for patients.” The paper goes on to quote Senator Ron Wyden (D. Oregon): The president “came into a [recent] meeting with that article having affected his thinking dramatically. He, in effect, took that article and put it in front of a big group of senators and said, ‘This is what we’ve got to fix.’”

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Alex Gibney, best known for his 2005 film, Enron: The Smartest Guys in the Room  and his 2007 Academy Award Winning documentary, Taxi to the Dark Side has made a 90 minute documentary of my book, Money-Driven Medicine: The Real Reason Health Care Costs So Much

The Century Foundation and the New York Society for Ethical Culture are co-hosting the New York premiere on June11,  7p.m.  at the New York Society for Ethical Culture, 2 West 64th Street at Central Park West. Doors open at 6:30.  Admission is free.  If you’re planning to attend, please RSVP  Loretta Ahlrich ahlrich@tcf.org  or (212) 452-7722 so that we can have a rough idea of how many people will be coming.

Alex Gibney will be there, and following the screening, he will take questions about film-making and I’ll answer questions from the audience about healthcare and healthcare reform.  
Here’s a clip of the opening sequence of the film: 

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Grazing online, I ran into this remark by Princeton health care economist Uwe Reinhardt.  Talking about “the essential difference between Americans and peoples elsewhere,” Reinhardt quotes author Ian Morrison: “In other countries, having health insurance is a right while owning a gun is a privilege. In the U.S. it is the other way around.” 
With that in mind, Morrison defines Canadians as “unarmed North Americans with health insurance.”
(Reinhardt describes Morrison as “a latter-day de Tocqueville.” Hat tip to the National Journal online where Reinhardt’s remark appeared.)

This week-end, I stumbled upon a story written by “BuckEye Surgeon” (Jeffrey Parks),  a general surgeon in Cleveland, Ohio that I found provocative.  Parks wrote the post back in 2007, but it’s just as relevant today as it was then.
The piece, which is titled “No Chance” describes how and why Buckeye operated on a patient who he knew had no hope of surviving. Whether or not this patient had an operation, he  was going to die. The post raises medical ethical questions, and reminds us that in the messy reality of hospitals—where human beings are suffering and dying—the answers are not always so clear-cut. I think BuckEye surgeon was brave to tell this story and that he tells it very well. Did he do the right thing?  I’m not a surgeon, so I’m not going to try to second-guess the physicians who read this blog. But I would say, from a patient’s point of view, if I (or a loved one),  had been the patient, I would be glad that Buckeye did what he did—for the reasons that he gives.  But I suspect I may not be in the majority on this one. Click here to read the post.
What do you think?