AMA Joins the Gimme Queue – But What do Doctors Say?

Listening to NPR recently, I heard that the AMA is supporting Obama’s attempt to change healthcare. That’s new. The AMA rejected all other attempts at reform before now. So what gives? The Chicago Tribune looked at this question.

And among the many reasons for the AMA’s historic shift is one practical consideration: Obama’s plan promises to provide millions of government dollars to help millions of patients pay their doctor bills.

Moreover, in a deal cut with Obama’s congressional allies that has made it into one of the principal health care bills pending on Capitol Hill, the government will rescind scheduled cuts in Medicare payments to doctors amounting to $228 billion over the next 10 years.

Critics denounce the deal as a fiscally irresponsible effort to buy the doctors’ support, while the organization and leading Democrats defend it as necessary to safeguard the stability of the medical system. But whatever the merits of the deal, it stands as the most costly concession to any single interest group made so far.

The AMA’s new position on the government’s role in health care reflects changes in both the organization and the economics of American medicine. With AMA membership in decline, what was once considered the capital’s most powerful single lobby was beginning to slip.

In the past, the AMA saw the government as endangering doctors’ incomes and independence. Now, with the advent of Medicare and other federal programs — which the organization originally opposed — the government has become a vital source of revenue and stability for doctors.

True enough. As private health insurance becomes more complicated, costly and patchwork, I can see where Medicare is at the very least, a known quantity for providers.

Doctors have become discouraged that more and more people are losing healthcare. I believe this; I’ve had many conversations with doctor friends about how they see the problems. Back when Bill Clinton took a swing at healthcare, the AMA did not support his effort, but clearly have changed their position. According to health insurance people though, the AMA’s change of heart is more quid pro quo than a prescription for a healthier public.

In the view of health industry analyst Robert Laszewski, a former insurance company executive who tracks health policy in Washington, AMA support is really explained by the deals the organization cut with congressional Democrats.

“They were bought off,” he says of the doctors’ organization. “And the price tag was $228 billion.”

Laszewski thinks that all of the major interests that once opposed reform, including insurance and drug companies, have received sweetheart deals in exchange for their support. But he thinks none is as sweet as the deal scored by the AMA, which many still regard as the nation’s premier lobbying force.

Laszewski and other critics focus their ire on a little-known section of the House Energy and Commerce Committee health bill that will relieve the doctors of scheduled cuts in Medicare reimbursement rates.

The scheduled cuts — called the sustainable growth rate, or SGR, cuts — were written into law in 1997. The idea was to prod the medical community into holding down health care costs by cutting back reimbursements to doctors under the mammoth Medicare program whenever Medicare spending outpaced the growth of the overall economy.

For the most part, the cuts were never imposed because doctors and other medical providers convinced Congress to override the SGR — with a catch: Each year that Congress blocked the SGR cutbacks, it made the following year’s scheduled cuts larger.

In 2010, the cumulative cut would be a whopping 21 percent.

From the beginning, eliminating the SGR was a top priority for the AMA, which has spent $30 million on lobbying since the beginning of 2008. Over the past decade, no other interest group or trade association has had a bigger lobbying budget, except the Chamber of Commerce.

There is argument about whether these rollbacks are fair or not, with Henry Waxman saying criticism of the deal isn’t fair. But it does seem to just push costs forward.

Still, says Lawrence Jacobs, a University of Minnesota specialist in health policy, “This was a big concession to doctors. Waxman, like any good reformer, is pushing costs into the future and emphasizing benefits in the near term. The magic of reform in America is to get stakeholders to focus on wins in the present and delay the cost as much as you can.”

Like much of the healthcare discussion, this little piece is more complex than it appears. I’ve got no problem with paying doctors well. After all, medical school is hugely expensive and it takes years to become a proficient doctor while others are already making money. And I’ve heard horror stories about what doctors actually get paid for their services, notwithstanding the bill the patient receives. Personally, I’d rather just pay the doctor directly. Paying someone for services is, aside from a monetary transaction, a way of thanking them for that service. But, that’s not the way it works and I understand the reasons why, having needed the services of a highly trained surgeon myself.

And according to IBD, even some doctors don’t agree with the AMA.

Two of every three practicing physicians oppose the medical overhaul plan under consideration in Washington, and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted, a new IBD/TIPP Poll has found.

The poll contradicts the claims of not only the White House, but also doctors’ own lobby — the powerful American Medical Association — both of which suggest the medical profession is behind the proposed overhaul.
———-

More than seven in 10 doctors, or 71% — the most lopsided response in the poll — answered “no” when asked if they believed “the government can cover 47 million more people and that it will cost less money and the quality of care will be better.”
———-

Recent population growth has been 1% a year. Patients, in short, are already being added faster than physicians, creating a medical bottleneck.

The great concern is that, with increased mandates, lower pay and less freedom to practice, doctors could abandon medicine in droves, as the IBD/TIPP Poll suggests. Under the proposed medical overhaul, an additional 47 million people would have to be cared for — an 18% increase in patient loads, without an equivalent increase in doctors. The actual effect could be somewhat less because a significant share of the uninsured already get care.

Even so, the government vows to cut hundreds of billions of dollars from health care spending to pay for reform, which would encourage a flight from the profession.

The U.S. today has just 2.4 physicians per 1,000 population — below the median of 3.1 for members of the Organization for Economic Cooperation and Development, the official club of wealthy nations.

This might explain why those concessions to the AMA were made. Perhaps the hope is that since the effects of the bill are not good for physicians, removing the Medicare cap will seem like they are not entirely getting messed over.

Like I said, it’s always more complicated. So, doctors lose on one hand and, hopefully, gain on the other. How’s that going to work out?

The article also says states that have tried an overhaul, such as Massachusetts, Tennessee, Maine and Hawaii, have run into problems with most having to cut back services to patients. Britain has to import doctors every year.

In Britain, a lack of practicing physicians means the country has had to import thousands of foreign doctors to care for patients in the National Health Service.

“A third of (British) primary care trusts are flying in (general practitioners) from as far away as Lithuania, Poland, Germany, Hungary, Italy and Switzerland” because of a doctor shortage, a recent story in the British Daily Mail noted.

British doctors, demoralized by long hours and burdensome rules, simply refuse to see patients at nights and weekends.

Likewise, Canadian physicians who have to deal with the stringent rules and income limits imposed by that country’s national health plan have emigrated in droves to other countries, including the U.S.

So, what to make of all this? Well, it certainly seems as if the AMA is pushing hard to remove the cap on Medicare, not necessarily out of greed but because they see bigger problems coming their way. The point is arguable, I know. Even as this makes some sense, instead of rethinking the problem, the AMA simply joined the gimme queue thinking that what is likely to be pennies on the dollar will appease its membership.

A couple of doctor friends have nearly $100,000 in medical school student loans to pay off. Even at low interest rates, that’s a second mortgage payment each month. They’ve got to be asking what the reimbursement rates for patients will be under any national plan.

Will they make out like bandits in this plan? I just don’t see it. The money must be elsewhere. But what did doctors actually say? IBD asked for comments. And they got them.

Our poll also invited those taking part to tell us the reasons why they didn’t like the health care reforms — or, in the minority of cases, why they did. The outpouring of written responses IBD received — about 1,300 in all — was stunning.
—–

In combing through the responses, we identified no fewer than 21 separate issues doctors felt either weren’t addressed or weren’t solved by proposed reforms. The issues are many, but boil down to three big categories: costs, controls and courts.

IBD reports that responding doctors worry about: socialism, lack of tort reform, government running medical protocols, paperwork with low reimbursement rates (Medicare and Medicaid), the disappearance of private insurance, and other issues quite familiar to town hall “racists.”

“Between the government and insurance companies, I now only collect 28% to 30% of billed charges. No other business can function at that rate,” this doctor added.

As many noted, all of the plans now being discussed would require massive tax hikes — and debt.

——–
Many of those who opposed the plan had a unique perspective: They had practiced or lived under national health care systems in other countries.
———-

“It will take away consumer choice, drive up health care costs, and drive down health care quality,” said one. “It will sharply increase the demand for health care providers and sharply decrease the supply as doctors like me will retire early and students will avoid the field.”

IBD will have comments from doctors supporting the plans in Friday’s edition. However, it notes those represent a minority of the doctors responding to their poll.

So, what do you think? Any doctor readers out there?