11 June 2009

There's something to be said for consistency

This is disappointing but entirely unsurprising:
A.M.A. Opposes Government-Sponsored Health Plan - NYTimes.com
As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan, which President Obama and many other Democrats see as an essential element of legislation to remake the health care system.
I had hoped that the AMA's expressed support of health insurance reform would extend to this more fundamental element of reform, but it was a fool's hope. The AMA opposed national health insurance in the '30s and '40s, and opposed the creation of Medicare in the '60s. So it would have taken something of a sea change in the outlook of the AMA for them to support a role for government in a reformed health insurance market. The reasons given, however, are chickenshit at their heart. By which I mean that they are fundamentally dishonest about the real reason the AMA is in opposition. The pretext:
“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.”
WTF? Since when does the AMA - a doctor's association - carry water for our blood enemies in the insurance industry? Truth is, they don't. This objection is ideologically coded to imply that the doctors are open to lining up with the republicans, but the real reason is more crass and not fit for a public audience: a public plan could drive down the income of physicians. There, I've said it. Oh, wait, I've said it before, too. What the AMA really fears is a public plan which is, in the common parlance, too "robust," by which I mean it would have the option to set reimbursement at, say 110% of the Medicare rate, and that it would compel physician involvement. That would indeed be a bad plan. Having said that, it's not at all the only version of the public plan in the mix. Schumer's principles for a public plan explicitly contradict these worst-case fears of the AMA. Why then did the AMA not endorse their preferred version of the plan (if they were even aware of it?). I don't know. It goes back to my long-standing opinion that the physician's lobby is incompetent and ineffectual in national politics.

Interestingly, the AMA is already frantically trying to walk this back:
AMA - AMA Committed to Health System Reform This Year
Today's New York Times story creates a false impression about the AMA's position on a public plan option in health care reform legislation. The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, but the AMA is willing to consider other variations of a public plan that are currently under discussion in Congress.
Yeah, I'm thinking that Nancy Nielsen saw the NYT headline and did a spit-take: "I said what?" And realized that maybe, just maybe, it might not suit the doctors' lobby to be on the wrong (i.e. minority) side of the "who's for dinner?" game being played in Washington DC.

Boy it's frustrating to have these guys as "our" advocates in Washington when it seems that they couldn't find their asses with two hands and an ass-finding device.


  1. Is it me, or is your font really small? I have a hard time reading it.

  2. it's you. You can increase the size of the font in your browser.

  3. Could somebody please enumerate the reasons why "they" think health care is broken?
    Maybe just the top five examples, then maybe we could work on fixing them and then list another five and work on them.....

  4. 1)How many millions of people don't have any kind of health insurance
    2)A large proportion of those people don't have employer offered insurance and cannot afford personal insurance
    3)A large proportion of those people have "pre-existing conditions" ranging from cancer to chronic illness and so are not welcomed by the insurance companies
    4)Insurance company negotiated pricing is so much lower than what individuals without insurance are charged
    5)There are many vital, life-saving drugs which are prohibitively expensive without insurance--these especially include things like biologic drugs which are key to treating cancer and auto-immune diseases

    So, Steve, how will you solve those problems?

  5. What do you think of the slippery slope aurgument here? Even if the Schumer principles are enshrined in the original rollout of the public plan, what is to stop congress from throwing them out the first time the public plan runs in to financial difficulties? Once its up and running, and millions of Americans are relying on it for their healthcare, it will be alot harder to hold the line on something liked medicare + 10%, or massive gov't funded subsidies if it looks like they are the only way to save the plan from bankruptcy.

  6. I suspect you're right--the AMA has reimbursement in mind behind the argument, but it can't explicitly say so.

    As beneficent as I'd like to think most physicians are, we're still economically driven in part, so overall lower salaries will attract fewer people to medicine. The best and the brightest students will go elsewhere. Lower physician salaries, therefore, translate into a lower-quality pool of physicians. We'll become more like technicians.


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