The AMA Says No To A Public Plan. Maybe.

You know, my primary care physician is particularly "liberal." My brother, the peditrician, isn't particularly "liberal." It doesn't take a "liberal" to look at your p and l at the end of the year, and see what the current system is doing to your practice. The private insurance system is a disaster for most doctors, requiring obscene amounts of administrative costs, putting their care decisions under scrutiny of people not competent to make those decisions, and spending inordinate amounts of time just getting paid.\
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It's not "liberal" to recognize this is completely broken. it's not "liberal" to recognize that morbidity and mortality are worse in the rest of the OECD, and at much lower costs than the US.
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The jamming of this issue into "liberal" and "conservative" lines is killing us. "Conservative" lies are given the same weight as facts. "Liberal" obfuscation, in the apparent interest of preserving the status quo is treated as part of an honest attempt to "compromise."
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This is a solved problem everywhere else in the OECD. It shows how unrepresentative of constituents this government has become.

If I thought the AMA was looking out for more than their members bottom lines I might pay attention to their concerns. However, since I don't I won't.

From the TNR link--
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"Still, a senior Democratic House aide points out the AMA's specific choice of language: A public option would not be "the best" way to deliver coverage. That's not quite the slamming the door, this aide says: "I see flexibility there."
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The reading of tea leaves that is done in the beltway drives me to distraction.
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So if the AMA isn't the power they once were are they just using the timing of their group being addressed by BHO to make their play?

Thanks for the update, Karen; your reporting and analysis on this issue has been invaluable.

Hmmm..."AMA"..."AMA"...
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Where have I heard of that organization before?

morbidity and mortality are worse in the rest of the OECD, and at much lower costs than the US.
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"than in"
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And a missing "not" in the first sentence.
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I apologize to my friend preview.

Just another special interest whining over a lost slice of the pie...

http://www.political-buzz.com/

KT:
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The question for journalists will be whether or not they can include the AMA's well-documented opposition to Medicare when it was proposed in the discussion of its opposition to a public plan now.
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Will "the AMA says" be allowed by the mediators of this debate to be used by Republicans, laissez-faire ideologues and profit-driven interests synonymously with "Doctors prescribe"?
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Again, political journalists will be the deciding factor, because their facile acceptance or clarifying contextualization of "the AMA says" will make the difference in ordinary people believing that they will or won't be allowed to see their doctors when they need to.
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Good luck with that responsibility, KT...am I wrong?

doctor leaves the AMA:
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http://www.dailykos.com/story/2009/6/11/741163/-Im-out-of-here:A-physicians-goodbye-to-the-AMA

As a Canadian, and a physician, the struggle to achieve health care for the American people is one of the most dismay-inducing misadventures I've ever seen. Like the federal and provincial medical associations in Canada, the AMA is taking the cake for talking out of both sides of its mouth as an "advocate" for the American people. At least the insurance giants come by their greed honestly, (or laughably if you count all the claims of "socialism" etc.)

It seems that plowing through with public health care to the chagrin of the AMA would serve not one but two purposes. First and foremost, of course, it would provide millions of un- and underinsured Americans with the security of health care. Secondly, however, it might in the long run decontaminate the medical profession from the rampant greed displayed today by the AMA and its membership.

The Dems got incredibly lucky, in a horrible way: the stock market tanked and suddenly private accounts (as in 401(k)s) don't look like such a good bet to count on for retirment.

Dems need to show some spine and show that the government actually does some things better than the market place because making a profit and shareholder concerns aren't a part of the picture.

They need to remind people that one reason so many of us now have less disposable money left over after we pay our monthly bills is due to our health costs. And that insurance companies have NO incentive to lower premiums unless they get so major competition.

KT:
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Have you by any chance read this amazing article in Time Magazine online called "The A.M.A. & Medicare"?
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It turns out that, at least according to Time Magazine, the AMA opposes Medicare!
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It's so interesting to read that

the American Medical Association said: “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.

, when the AMA has such an anti-Medicare position:

The American Medical Association's 115th annual convention in Chicago last week wound up just in time for the doctors to go home to deal with the consequences of Medicare, the social security-administered medical insurance that so many of them had fought against so vehemently and so long.
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...the new president [of the AMA], Dr. Charles Hudson, a Cleveland internist, counseled moderation. "There are people who think doom is going to fall in on us," he said. "I think this opinion is not justified. We are not stepping off the brink into a bottomless pit of professional destruction and despair." He proposed that doctors "make the most of this new program." If they do, he suggested, they may help "prevent its extension toward a national health service."
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The delegates' stance on billing was strong evidence that the majority of A.M.A. policymakers are not yet ready to adjust to the new program. The delegates obviously thought that the fight should and will go on. and to prepare for the future they elected Dr. Milford Rouse by acclamation as the next A.M.A. president. Rouse, who will take office in June 1967, is a Dallas gastroenterologist and a former director of H. L. Hunt's ultra-right Life Line Foundation. As speaker of the house of delegates, he has already made it clear that he will take a far harder line on Medicare than moderate Dr. Hudson.

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So how about that, KT?
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Before discussing the AMA's position on a public insurance option being made available to every American, journalists probably need to ask the AMA about their position with respect to Medicare, since it looks like they're almost fanatically opposed to it.
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Has anything changed, KT?

An' th' 2/3 or so (fergot me link - sorry - it be in one o' Stuart's recent posts in a similar thread, if I be rememberin' correct) o' those currently possessin' tha' magnificent private insurance that be moren' ready t' jump ship an' partake o' th' public option, if available? Wha' be th' AMA sayin' about tha'?

Achieving Health Care Reform — How Physicians Can Help
Elliott S. Fisher, M.D., M.P.H., Donald M. Berwick, M.D., M.P.P., and Karen Davis, Ph.D.

This year, we have the best chance in a generation of enacting legislation worthy of being called health care reform and of setting the United States on the path to high-quality, affordable health care for all Americans. The recent commitment by several major stakeholders — including the American Medical Association — to slowing the growth of health care spending is a promising development. But the controversy about whether the organizations actually agreed to a 1.5-percentage-point reduction in annual spending growth is just one indication that success is still far from assured.

Two threats in particular put reform at risk: conflicting doctrines (regarding the creation of a new public insurance option and government support for comparative-effectiveness studies) and opposition to change among some current stakeholders. In the face of this uncertainty, physicians have a choice: to wait and see what happens or to lead the change our country needs. We'd prefer the latter.

Physicians should first help to create a shared vision that could overcome doctrinal divides — and bring providers together to create a system better aligned both with public needs and with providers' fundamental interests and values. The starting point is to recognize, as most physicians do, that improving a complex health care system requires action on multiple fronts. In its landmark report Crossing the Quality Chasm, the Institute of Medicine (IOM) described a "chain of effect" that links systems at four different levels as the interrelated determinants of health care quality that must be aligned for reform to yield the desired results.

The first level is aims. For health care reform, we propose that physicians, through their advocacy, help lead the country to embrace the so-called triple aim: better experience of care (safe, effective, patient-centered, timely, efficient, and equitable), better health for the population, and lower total per capita costs.1

The second level is the design of the care processes that affect the patient — clinical "microsystems." Health care microsystems are famously unreliable, variable in costs, and often unsafe. Physicians, through their participation in quality-improvement initiatives in their practices and hospitals, can and should lead the needed changes in the systems of care in which they work, to make them safer, more reliable, more patient-centered, and more affordable.

However, neither physicians nor anyone else on the front lines can improve care much on their own. Their most important source of support for improvement is the third level described by the IOM — the health care organizations that house almost all clinical microsystems and can ensure coordination among them. We need organizations large enough to be accountable for the full continuum of patients' care as well as for achieving the triple aim. We will create a high-performing health care system only if integrated delivery systems become the mainstay of organizational design. Organizations could be virtually integrated, such as networks of independent physicians sharing electronic health records and administrative and clinical support for care management and quality improvement, or structurally integrated, such as multispecialty group practices or staff-model health maintenance organizations.2 Fostering the development of such accountable care organizations need not be disruptive to patients or providers: almost all physicians already work within natural referral networks that provide the vast majority of care to patients seen by the primary care physicians within the network.3

The IOM's fourth level is the environment, which includes the payment, regulatory, legal, and educational systems. On this front, too, we need physician advocacy. The United States cannot achieve the triple aim without health insurance for everyone. Integrated delivery systems that are accountable for populations won't thrive unless payment systems encourage their development and unless we change the laws and regulations — including proscriptions of gainsharing and anti-kickback rules — that prevent cooperation among health care professionals and organizations.

If stakeholders can agree on such a vision of health care reform, perhaps we could shift our focus from the conflict over whether a new public plan should be created to a more constructive insistence that all health plans, whether public or private, focus on the development of professionally led, integrated systems.

The second and largest threat to reform, which looms ever larger in a weakened economy, is the possibility that Congress will conclude that expanding coverage to all the uninsured is unaffordable. Without some guaranteed savings, skeptical watchdogs, such as the Congressional Budget Office, are unlikely to accept the vague promise that integration will save enough money to offset the cost of coverage expansion.

So how might physicians help us all "get to yes"? The first step is to acknowledge that delivery-system reform offers a potential win–win situation for providers. Physicians should support and help to develop integrated systems of care. Integration pioneers that have arranged new, population-based payment models — such as the Geisinger Health System in Pennsylvania — have achieved substantial savings while preserving generous net incomes for physicians and hospitals.3,4 Such integrated systems also have strong incentives to invest in primary care.

The second step is for physicians to recognize that achieving savings sufficient to cover the cost of expanded coverage need not impose a hardship on patients or providers. A 1.5-percentage-point reduction would still allow spending — and thus the total incomes of providers — to rise from $2.6 trillion in 2010 (17.7% of the gross domestic product [GDP]) to $4.3 trillion in 2020 (18.5% of the GDP). But because of the miracle of compounding, a "11/2-percent solution" that reduced the growth in annual spending from 6.7% to 5.2% could save the health care system $3.1 trillion of the $40 trillion we are currently projected to spend between 2010 and 2020, according to the Lewin Group.

If health care providers and suppliers could actually achieve this reduction in growth rates, the federal government would harvest about $1.1 trillion in savings over the 11-year period — enough, perhaps, to close the deal on affordable health insurance for all. Others would also see savings: $497 billion for employers, $529 billion for state and local governments, and $671 billion for households. One simple way for physicians to start contributing to this goal is by reassessing and scaling back, where appropriate, their use of clinical practices now listed as "overused" by the National Quality Forum's National Priorities Partnership.5 Ideally, providers would also agree to slow fee increases for private payers further, allowing Medicare to catch up.

The Congressional Budget Office, however, is unlikely to score as savings purely voluntary restraints on price increases. It may therefore be necessary to set a legislative target for the growth of spending at 1.5 percentage points below currently projected increases and to grant the federal government the authority to reduce updates in Medicare fees if the target is exceeded. These moves would guarantee near-term budget savings while building a foundation for fundamental payment reform.

The final step is to craft a deal that all stakeholders can support. We suggest linking the proposed savings of 1.5 percentage points both to health insurance for all (which will result in revenue gains for providers who deliver care to the newly insured) and to comprehensive reform of the delivery and payment systems. The reforms should encourage providers to establish accountable care organizations through an array of incentives, including the adoption of innovative payment models, such as shared savings, bundled payments, or global fees for care; a shift toward performance measures that reinforce providers' shared accountability for health outcomes and care coordination; and a requirement that subsidies for electronic health records be available only to providers demonstrably on the path toward integrated care. With new global payment methods and strong organizational support for clinical improvement, providers, patients, and payers would all gain from the elimination of wasteful care and avoidable complications.

Ultimately, we believe that the United States can reduce its per capita health care costs — without harming patients — by much more than the proposed 1.5-percentage-point reductions in growth would shrink them. But let's make that deal stick. Physicians can become our most credible and effective leaders of progress toward a new world of coordinated, sensible, outcome-oriented care in which they and their communities will be far better off. Defending the status quo is a bankrupt plan, and physicians have an opportunity to help us all see beyond it.

Dr. Fisher reports receiving grant support from Aetna and consulting, teaching, or speaking fees from Regence Blue Shield, RAND, Kaiser Permanente, the Center for Corporate Innovation, Blue Cross Blue Shield of Montana, and numerous provider organizations and medical associations. No other potential conflict of interest relevant to this article was reported.

Source Information

Dr. Fisher is a professor of medicine and of community and family medicine and associate director for Population Health and Policy at the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH. Dr. Berwick is a professor in the Department of Health Policy and Management, Harvard School of Public Health, Boston, and president and chief executive officer of the Institute for Healthcare Improvement, Cambridge, MA. Dr. Davis is the president of the Commonwealth Fund, New York.

This article (10.1056/NEJMp0903923) was published on May 20, 2009, at NEJM.org.

Sorry about the long post, but a snippet would have overlooked important details

An answer to the question, where's Joe?
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http://www.time.com/time/world/article/0,8599,1903966,00.html

"Make no mistake: health reform that covers the uninsured is AMA's top priority this year," a clarifying statement from the group read. "Every American deserves affordable, high-quality health care coverage.
AMA offers a clarification on it's statement
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"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 the public plan that are currently under discussion in Congress. This includes a federally chartered co-op health plan or a level playing field option for all plans. The AMA is working to achieve meaningful health reform this year and is ready to stand behind legislation that includes coverage options that work for patients and physicians."
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http://www.huffingtonpost.com/2009/06/11/obama-reasserts-support-f_n_214392.html

Thanks so much for the updates, rmrd.
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The AMA opposes any public plan that...pays Medicare rates
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Slightly rephrased, that would be:
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"The AMA opposes any public plan that ultimately reduces the cost of insurance to consumers."

Isn't it great to know that the AMA and honest, thoughtful policy expert Karl Rove are on the exact, same page?

[...] Posted by Karen Tumulty | Comments (0) | Permalink | Trackbacks (0) | Email This Re our earlier post, we now get this from the American Medical Association: Statement attributable to: Nancy H. [...]

stuart, an important factor will be where the family practice and sub-specialty groups land on the issue. The AMA is very reactionary.
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Medicare rates are scheduled to decrease. Private reimbursement will likely follow. Even before the current economic situation, physician incomes were going to decrease. Doing more for less is a common refrain.

Note rmrd that reducing rates for procedures is likely to increase costs, because docs will pressure for more unnecessary procedures to be ordered. It really is important to read Gawanda's New Yorker article. That takes the insurance companies out of it, because it is just Medicare providers. Fixing this is not simple, in the sense of a path through corruption and dishonesty is tricky. But there are clear cases of how to provide good patient outcomes, and satisfied, reasonably well paid doctors.

jayackroyd, I disagree, for example, as data comes out that patients with stable coronary disease including diabetics do as well with medication as they would with angioplasty, the rate of angioplasties will fall. Additionally there will be a decreased tendency to screen asymptomatic patients with 64-slice scanners.
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Debate in urological oncology is centering around which patients with prostate cancer should actually undergo surgical resection. This is occurring despite an increase in the ability to detect small prostate tumors.

[...] Two posts from Karen Tumulty, here and [...]