May 13, 2013 | 72 comments
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April 15, 2013 | 159 comments
The Democrats fail to respect the AMA in the morning.
During the health care reform debate, while ignoring the throngs of angry Americans who took to the streets all across the country to protest the looming passage of ObamaCare, the White House and its congressional allies were very attentive to the constituents they valued. Mindful of the mistakes that had doomed Hillarycare in 1993, they worked assiduously to co-opt health care industry “stakeholders.” The American Medical Association was by far the most important target of this strategy. Its shrinking membership notwithstanding, the AMA was still seen as a force to be reckoned with inside the Beltway and continued to enjoy considerable public esteem. Thus, Obama and the Democrats badly wanted their flagship social program to benefit from the political and PR advantages that come with the AMA’s stamp of approval.
This was fortuitous for the AMA. It had a big problem called the “sustainable growth rate formula” (SGR). Created by the “Balanced Budget Act of 1997,” SGR was meant to slow the growth of Medicare spending by tying physician payment increases to the expansion of Gross Domestic Product. And, because the cost of providing medical care grows faster than GDP, this formula guaranteed annual payment cuts for doctors who treat Medicare patients. The AMA has pressured Congress to repeal SGR and replace it with a system that tracks medical cost inflation, but this “permanent fix” has never materialized. Congress has instead opted for a series of last-minute, short-term fixes. Meanwhile, the cumulative payment cuts mandated by SGR hang over the medical community like the Sword of Damocles.
Thus, the AMA saw the push for ObamaCare as an opportunity to get SGR deep-sixed once and for all. Instead of fighting them, as it did during the 1990s, the venerable physician association decided to climb into bed with the Democrats. In exchange for an implicit promise to finally enact the long-sought permanent fix, the President of the AMA became a high-profile cheerleader for “reform.” J. James Rohack, who has since been succeeded by Dr. Cecil Wilson, began promoting ObamaCare at press conferences and in effusive opinion pieces. Failing to notice the countless broken promises that lay strewn in Obama’s path to the Presidency, Rohack wrote: “I saw firsthand at the White House this week that the physicians’ perspective and commitment is valued as lawmakers work on reform.”
In the end, however, “the physicians’ perspective” wasn’t valued quite as highly as Dr. Rohack was led to believe. The permanent fix was conspicuously absent from the final health care bill signed by the President in March, and the ObamaCare cost estimates promulgated by the Democrats assumed that SGR will stay in place. Nonetheless, still clinging to sweet memories of White House tête-à-têtes, the credulous medico continued throughout April to rhapsodize about ObamaCare. Implausibly claiming that “reform” would improve competition, provide more choice in the insurance marketplace, and reduce administrative burdens, Rohack was determined to keep his smile in place as he stood waiting at the altar.
He was still waiting at the end of May. The House had passed a temporary fix, which the AMA pronounced inadequate, but the Senate refused to go along even with that half-measure. By June 1, when a 21 percent cut in the Medicare payment rate was due to take effect, Rohack finally understood that he and the AMA had been …ah … had. And Hell hath no fury like a surgeon scorned. On June 3, the seething sawbones denounced the Senate’s irresponsibility, accusing Reid & Co. of going on vacation while the nation’s seniors and their physicians waited for relief. He went on to unsheathe what he evidently thought would be a deadly weapon: “Today, the AMA is unveiling a new multi-million dollar ad campaign encouraging the public to contact their Senators and tell them to get back to work and fix Medicare now.”
The Democrats of “the world’s greatest deliberative body” were, however, not impressed. When the Senate finally returned to work, it passed a temporary measure even less satisfactory to the AMA than the House bill — a “doc fix” that put off the Medicare payment cuts for a mere six months. Then, adding insult to injury, Nancy Pelosi refused to allow a House vote on that measure until the Republicans agreed to support a “jobs bill” they had absolutely no interest in passing. The GOP gleefully pleaded with Pelosi not to throw them in that briar patch while the AMA’s new President, Cecil Wilson, cried foul and began to rend his clothing. Meanwhile, calculating that Congress would eventually grant yet another of its last-minute reprieves, the bureaucrats at Medicare halted payments to all physicians.
At length, as Congress prepared to head home for recess, the Democrats tossed a pittance in the direction of the weeping Dr. Wilson and thanked the AMA for its trouble. The country’s largest physician association had completely compromised its integrity and received virtually nothing in return. Rohack and his fellow quislings delivered their patients and colleagues into the hands of Washington’s health care bureaucrats in exchange for yet another temporary reprieve from Medicare payment cuts. They whined about Beltway perfidy, but had little choice but to accept a short-term fix set to expire immediately following the midterm elections, when neither the Democrats nor the Republicans will have any incentive to cough up the $240 billion required for a permanent solution to the SGR mess.
Even worse, the once-feared physician lobby has revealed itself to be far weaker than most, including the organization’s membership, realized. The people that matter inside the Beltway now openly wonder how much clout the AMA actually wields. Sadly, it didn’t have to be this way. Dr. Rohack could have used his organization’s influence to encourage genuine free market reform. Instead, he decided to climb into bed with people whose only interest in the health care system involves how much power and money they can squeeze from it. And, now that the White House and its congressional allies have gotten what they wanted, they will treat the AMA like the cheap date it has become. Such are the wages of collaboration.
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