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The AMA Takes a Shocking Stand
The AMA has announced that it will oppose the creation of a public option in any kind of healthcare reform. This is not exactly a shocker, since the AMA has opposed pretty much every step toward national healthcare ever proposed — including Medicare. Remember Operation Coffee Cup?
Still, they really ought to have better reasons than this:
In comments submitted to the Senate Finance Committee, 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. 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.”
If private insurers are pushed out of the market, the group said, “the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.”
The AMA's love affair with private insurance companies is truly a thing of wonder. It's like these guys have collective Stockholm Syndrome. Or collective battered wife syndrome. Or something. Given how much misery private insurers cause for most doctors, I sometimes wonder what they'd have to do to finally cause the AMA to turn on them. Start paying all claims in zlotys? Demand that doctors have bar codes tattooed on their foreheads? Insist that all waiting rooms show nothing but reruns of House?
Probably not even that. Doctors must figure that the more pain private insurers cause them, the more it shows they really love them. So back to the arguments, such as they are. (1) A public plan wouldn't drive out private insurers unless it turns out that private insurers are actually less efficient than the post office. In which case they'd deserve it. (2) Nor would a public plan restrict choice — unless the AMA's members deliberately tried to sabotage it by refusing to participate. (3) And there would only be a surge in signups if the public plan turned out to be a better deal, which would likely mean lower overall costs even if a greater percentage of those costs was paid for out of taxes.
But who cares? Honestly, if the graybeards of the AMA didn't oppose a public plan it would probably make me rethink my support for it. The fact that they are opposing it just means that all is right with the world.
UPDATE: Apparently the AMA is backing off slightly on its opposition to a public plan. They now say they're willing to consider "a federally chartered co-op health plan or a level playing field option for all plans" — whatever that means. Sounds like pretty weak tea to me. I think we can still safely say they're opposed to anything that would have a serious chance of being effective.
As an ex-pat living in
As an ex-pat living in Poland and paying for my health care in zloties, I can tell you that my zloties go a lot further than my dollars did for routine appointments and meds. A 3 month supply of my meds plus the appointment and tests runs about 180pln or less than $60.
I attribute it to a
I attribute it to a combination of greed (the division among private insurers means that there is very weak downward pressure on doctor's wages barring those in groups like Kaiser Permanente and such) and a residual fear that they'll end up in something like the NHS.
It could also be the result of a streak of conservatism from doctors - does anyone have polling suggesting how doctors tend to vote on a partisan basis?
It's the 2009 version of the
It's the 2009 version of the 1950's Red Scare but instead of accusations of communism, it's greed. We squint our eyes, raise our hands, point a finger and shout "Greedy".
Yes, that's it. You've analyzed it perfectly. They- the AMA, bankers, Wall Street, the Rich, anyone we disagree with- they're all greedy. But not the politicians, they uh are looking out for our best interests. That is if you define our best interests as them being re-elected on promises of give away programs so they can continue to look out for our best interests.
Excellent post. I look forward to your in depth analysis of union concessions at Goverment Motors
very droll
Gosh, thanks for the arch comment. There's nothing wrong in general with wanting to make more or even the same amount of money. However, when that reasonable, individual desire conflicts strongly with the public policy goal of having fewer people sicken and die -- in the richest country in the history of the world -- then yes, that's greed on top of indifference to suffering.
The members of the AMA can go pound sand up their asses.
Why should this be
Why should this be surprising ? The AMA is concerned that a public system would drive down costs and hence doctor wages, especially at the lucrative specialist level. Whatever pressure private insurance companies exert, a single federal program would be much more powerful.
Doctors aren't evil at all, but they aren't saints either. They are looking to expand/maintain their incomes. No different from private insurance companies.
Don't you mean "No different
Don't you mean "No different than anyone else?" Wasn't that the point of of Kevin's fund raising appeal, to expand/maintain their income? I mean is there something wrong with that as long as it operates within the bounds of law?
Nothing legally wrong with
Nothing legally wrong with it at all, but of course -some- think that greed is one of the seven deadly sins. They'd probably say there's something -morally- wrong with the drive to always expand one's income at the expense of others' health.
And of course this is why we need to change the law.
Actually...
...greed *is* one of the seven deadly sins:
Extravagance
Gluttony
Avarice
Sloth
Wrath
Envy
Pride
AMA Membership
So, the "AMA" is against a public option... I wonder where the AMA membership stands.
It would be fascinating to see if there are major differences in opinion among specialties. I suspect there is a direct correlation between how much money a doctor is making today and how likely they are to support a public option!
test
This is a test of how many times I need to enter secret words
AMA speaking for doctors?
The AMA is not the same thing as "the nation's doctors".
Here is an analogy: People tend to think that AARP is an affinity group for retirees, and the AARP finds it useful to let people assume that AARP is the voice of retirees. That assumption gives it political power, as if it wields a bloc of votes. However, AARP is simply a company that markets insurance products to people over 50.
Again: People assume that a regulatory agency rides herd over the industries that it regulates; but we know that in many cases the regulatory agencies have been co-opted and become complicit with those industries.
Again: Many of us have been angered by political positions taken by the national leadership of some union or church that we belong to.
Mr. BureauCat -- If you do
Mr. BureauCat --
If you do not change your picture, I will challenge you to a competitive round of tap dancing -- and I am good.
Dopplegangers!
Yikes! Get out the DNA testing kits -- Apparently you're my ideological brother, separated at birth. And we're both dancers -- in my case, ballroom.
You can be Rosencrantz, and I'll be Guildenstern. Or vice versa, it doesn't matter.
I do seem to have a doppleganger somewhere. For instance, a lady was sure that I worked as a waiter in a certain restaurant, and I almost went there to see what he looked like, but I stopped myself when I realized that I already know what he looks like (the handsome devil!). I don't care as long as he doesn't do anything that would get me arrested.
Somehow this reminds me of what Abraham Lincoln said when he was accused of being two-faced. To paraphrase: "If I had another face, why would I go around wearing this one?"
AMA is like AIPAC
Just like sensible Jews don't get leadership positions in AIPAC, sensible doctors don't get leadership positions in AMA.
This Must Be Right
Every physician I have ever had hates the insurance companies. They want to go on with a system that requires referrals, pre-approvals, etc.?
Pathetic
tagged as:- solution
As a newly minted M.D., all I can say is that the AMA doesn't speak for every doctor. Mostly the older, richer, more Republican ones, it seems.
The AMA has lost significant
tagged as:- solution
The AMA has lost significant membership and PAC funding, and its influence, while still powerful, doesn't have the degree of impact it once did.. While it used to represent the interests of a majority of physicians, if I recall, its membership now continues to drop precipitously and represents only about 30%of licensed physicians in the US. The Physicians for a National Health Plan organization actually more accurately represents the overall interests of physicians, and it addresses the concerns of primary care physicians much more accuracy and force than does the AMA.
The American Nurses Association, the AMA's professional cousin, has also failed to represent its profession's interests, as charged in its mission, and it too has lost vital membership. The American Association of Colleges of Nursing is the organization where nurses and the public can find pertinent professional stances, a wealth of information about the profession and patient outcomes/advocacy, and a much more accurate portrayal of the interests of the nursing profession.
Where does the ACP (American
Where does the ACP (American College of Physicians) stand? How about nursing organizations? I worry that many individuals will conclude that because the AMA is opposed, then doctors as a group are opposed. And we all know that if doctors are opposed, then something's got to be wrong with the plan.
Why does the AMA appose public health care?
Easy: they know that however bad the private insurance companies are, the government will be worse.
I looked in to see if you had anything to offer for Letterman's comments on Sarah Palin and her daughter. Nothing. I guess that means you're OK with dirty old celebrity men leering while telling sexually suggestive jokes about young girls and women on widely watched TV shows.
Oh, wait. You're an aging white guy. I guess the kind of attack on Sarah Palin which you featured a few days ago will start to have sexual overtones a few years down the road.
Suggestive jokes about unwed
Suggestive jokes about unwed Republican teen mothers who advocate for abstinence, while their mothers' publicize their ignorance of current affairs, are quite funny.
Why does the AMA appose public health care? Response
"Easy: they know that however bad the private insurance companies are, the government will be worse."
-How do they *know* this? Because you believe it? Mind if I interject some facts into your insulated worldview? Medicare runs at a 3% overhead. Private insurance run around 30%. Translation: government=better
And what does the Palin/Letterman thing have do to with any of this? For the record, if you subtracted Palin's IQ from Letterman's, he'd still be smarter than every GOP presidential candidate in my lifetime (I'm 40).
Doctors are greedy
Doctors are just greedy, full stop. Their incomes are enormous and the real reason health care in the US is so damn expensive. They deliberately keep training numbers down to keep their incomes up. They are a disgrace and must be taken on. They should be ashamed of themselves.
Stop. Apparently you have no
Stop. Apparently you have no idea what has happened to family/general medicine doctors in the past dozen years. No, they are not greedy and they literally are working for no money. It's a sad state of affairs that is going to catch up to us very soon as few want to go into that side of medicine. Unlike what you have written this is not just an opinion but a statistical fact. Not that I'd expect that to change your opinion.....
Agreed.
Again, I know only one family doc, who's the senior partner in an 8-doc family practice. He works like a dog, spends more time on admin issues than on providing care, and makes a lot less, a whole lot less, than I thought he would and, in all fairness, than he should. His kids need loans to go to college. Now, nobody should cry for him, but he's a long way from the greedy, high-living doctor pictured here, and his situation is a structural result of the current health care "system", not a lack of ambition or smarts or caring. It's hearing from him that makes me think that many doctors are ready for changes.
One reason why GP's work so
One reason why GP's work so hard is they are usually sole proprietors, building up practices. If they worked for public managed clinics, all they would have to do is be medical doctors serving sick people. Instead they are HR managers, financiers, real estate investors, buyers, insurance document specialists and insurance/Medicare/Medicaid payment specialists before they can begin attending to their patients.
great graphic!
Now see how far we haven't come in the past 20 years.
Wake Up America 1991 Jimmy Dortmundt
political music video made before Bill Clinton ran for president.
http://www.youtube.com/watch?v=1eItXtSIOvQ
It's cultural, I think.
It's cultural, I think. Doctors generally like to rely on the sort of techniques to which they are accustomed, under the pretense of science, even when the scientific justification is weak. And of course any time you discuss doctors, you need to throw in the word "arrogant" at some point. It explains a lot.
Small percentage of docs actually belong
According to Scott Morrison of Polite Dissent:
If I were to do a 2nd draft
If I were to do a 2nd draft of the above, I'd replace "like to rely on the sort of techiques to which" with "will generally prefer whatever...to" There, that's better.
It's pretty clear to me that
It's pretty clear to me that it's all about doctor wages. They may complain about insurance companies but when it comes down to it they know they are currently overpaid. There was a nytimes article a couple of years ago comparing doctor salaries in the US and Germany. The basic summary was that they earn 2-3 times more in the US - and being a doctor is still considered a solid upper middle class job in Germany.
But this isn't Germany. Why
But this isn't Germany. Why not compare their wages to those earned in the outback of Australia? How can this possibly be relevant to the discussion?
You want MDs to make less? make it less expensive to become one
If German docs left medical school with debt equivalent to a nice-sized house in most parts of the country, they'd ask for more too. You can't realistically ask people to decrease their income potential while at the same time making it more and more expensive to enter the field. Medical education absolutely has to be subsidized as part of a public insurance plan. It's amazing how fast the altruism of a 23 year old will diminish once they learn the little economics lesson of $250,000 at 6.8% interest. No matter your intentions, a small part of you feels like you deserve at least the salary you'll make because you not only gave up 4 years of making income (plus only making an hourly wage of about $12 during residency), you paid a boat-load of money to do it. That's a lot of catching up to do in terms of retirement, kid's college, buying a house, etc.
Greedy doctors
As others have said, don't conflate the AMA with "doctors." More don't belong to the AMA than do. They're disgusting. I nearly puked when I got my first junk mailing from them in medical school. Specialists who have helped set up the reimbursement rules to favor them over the years are afraid of this change, because they know that their salad days might be over. But not all of us are greedy, or overpaid, especially in the primary care areas.
What do real doctors think?
Just because the AMA has taken an official position, that doesn't mean that most health care professionals feel the same way. As dru's post indicates, the health care "system" is so screwed up, in so many ways, it's hard to know where to start. But, my guess is that most docs aren't happy with the way things are. Based on my sample size of one, my brother-in-law, the practice of medicine today is not what many doctors thought it would be when they went into the field. And it's not just the money; it's the pressure to process patients, the paperwork, the legal issues, personnel, etc. For my brother-in-law, the actual practice of medicine has taken a back seat to running a small business, which is not what he wanted to do. I think there is a high level of professional dissatisfaction with the field of medicine among doctors that could help the reform effort if it could be channeled in a productive way. Any more docs out there who can comment?
Finally! A sensible comment!
Finally! A sensible comment!
It's time to hit them where
It's time to hit them where it hurts and mandate an increase in medical school enrollment using widespread federal grants and loans.
Threaten to double the number of plastic surgeons and dermatologists and we'll see how quick they put down the pinot noir.
most doctors receive socialized educations
Most doctors receive socialized educations. A large part of doctors' revenues are paid for by wealth transfers. The public has large investments in health care, but receives little return on them and has little oversight over how health care is distributed, partly because insurance companies and partly because the doctor's guild use their institutional and economic power to prevent improvements that would increase the availability of heath care. Since the public subsidizes so much of the medical industry's wealth, through education and social services, it is time it used its power to mold the medical industry to serve its needs, rather than serving the needs of insurance companies and preserving the privileges of those who have received socialized educations.
Best care anywhere
I recently had my eyes opened on this subject by Phil Longman's book Best Care Anywhere. Walter Reed notwithstanding, the Veterans Health Administration delivers the best health care America has to offer, at the lowest cost. With many of the sickest patients, they practice smart preventative care (which simply isn't cost-effective in the private sector, since people switch plans so much--why pay to keep someone healthy when someone else is going to benefit), and can boast the best outcomes. Their medical IT system, built bottom-up instead of top down, should be a national model; the VHA has virtually eliminated the medical errors that plague private hospitals, despite a recent glitch in the system that was quickly fixed. By taking publicly provided care out of the equation, we are quite directly eliminating the best thing we've got.
Here's a link to Longman's book on Amazon: http://www.amazon.com/Best-Care-Anywhere-Health-Better/dp/0977825302
And a link to a long review from Kevin's old employer (which has the title wrong but gives a pretty good synapsis):
http://www.washingtonmonthly.com/features/2005/0501.longman.html
Michael Mechanic is a senior editor at Mother Jones.
Michael, As another poster
Michael,
As another poster noted, Walter Reed is an U.S. Army Medical Center, separately managed by the Army Medical Corps and has nothing to do with the VA medical system.
As for your reference to Walter Reed as an example of poor medical care, I suggest you research the troubles that plagued Walter Reed before coming to that conclusion. The issue with Reed was always the housing conditions some of the recovering ambulatory patients had to endure and the failure of Army leadership to address those conditions in a timely manner. As well, the bureaucratic hurdles faced by these soldiers, many of them thanks to your venerable VA, were compounding the physical pain they suffered due to their injuries. The quality of the inpatient medical care received by our soldiers was always excellent and was never even an issue of the articles written by the two Washington Post reporters.
The AMA is giving doctor's a bad name.
Since AFAIK the AMA speaks for only a third of doctors I wonder if there is some other organization that will speak for the rest of the doctors.
Otherwise the AMA is to Doctors as the Taliban is to Islam.
Tripp
VA?
Just as an aside Walter Reed (or any military hospital) is not the same as the VA hospital system.
And it has always been a fact of life that if you want something to be really screwed up, then have the government run it. The "timely" delivery of mediacal care will be the first, but certainly not the last victim of a government health care system. Just when most of Europe is trying to get away from government health care we are about to jump into the abyss - why????
Complete nonsense.
You know, just when people are having a good discussion, there's your turd in the punchbowl.
"And it has always been a fact of life that if you want something to be really screwed up, then have the government run it"
This is the brainless, self-serving conservative mantra spouted without regard to facts. Governments run health care systems the world over, with measurably better and cheaper results than our craptastic mess. Do you even bother to find out about stuff before you spout off? Jesus.
"Just when most of Europe is trying to get away from government health..." Please provide some backup for this. Really. And not on some wingnut website. Then go away until you have something value to add.
House? You've got a problem with House?
House is great. Is it because the actor is British? Is it the cane? Get over it.
Who's education is socialized?
TPX, which American trained doctors are you referring to? The only people I know who will have less than 6 figures in educational debt after medical school either have very wealthy parents or are on military scholarships. True, our tuition probably doesn't cover the entire cost of training us, but the real cost + opportunity cost of going to medical school is well over 300-400k for most US trained doctors. I'm all for a public plan, I just think that until the costs are shifted away from the medical students people will continue to flock to high paying specialties and fiercely resist any change that is (however wrongly) perceived to take away from their bottom line.
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All public universities
All public universities provide subsidized education for all of their students. Tuition does not cover the cost of education at public, land grant state universities. Despite the costs medical students pay, their educations, because of their length, are subsidized more than most. Even the student loans are subsidized, and the greater the amount borrowed, the greater the subsidy. If health care providers do not want to work within a public health care system, they should receive all of their medical training from the private sector and eschew all public payments for their services.
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All public universities provide subsidized education for all of their students. Tuition does not cover the cost of education at public, land grant state universities. Despite the costs medical students pay, their educations, because of their length, are subsidized more than most. Even the student loans are subsidized, and the greater the amount borrowed, the greater the subsidy. If health care providers do not want to work within a public health care system, they should receive all of their medical training from the private sector and eschew all public payments for their
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The Public Insurance Plan
The Public Insurance Plan that President Obama is proposing would be a disaster for the US economy, health care costs and quality of health care. Under President Obama"s Public Insurance Plan the government would mandate not only that you must buy health insurance, but what health insurance counts as "qualifying." Everyone would have coverage but only those who are deemed as of "worth to society" or has been diagnosed with a politically correct ailment would be covered. That translates into denying care to the elderly and putting to government in charge of deciding what diseases to cover based on political favoritism.