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AMA President Talks About Health-Care Reform
Yesterday, I spoke with Nancy Nielsen, president of the American Medical Association, for a longer piece I'm writing about the prospects for health-care reform. I thought that in the wake of yesterday's appointment of Tom Daschle as Secretary of Health and Human Services, it would be worthwhile to explain the thinking of the influential physicians' group.
Historically, the AMA has vociferously opposed efforts to expand the government role in health care (see, as an example, this classic 1961 LP "Ronald Reagan Speaks Out Against Socialized Medicine" that was recorded on behalf of the organization).
The AMA now sees covering the uninsured in some type of universal health care plan as an urgent matter. Nielsen was sure to emphasize repeatedly that, "We are not in favor of government-run health care." The group's own proposal in many ways mirrors the one John McCain put out during the campaign by shifting the tax subsidy on employer-based insurance to individuals.
Nielsen made it pretty clear that the current AMA thinking is that if health care reform is inevitable, they'd much rather have a place at the table than draw a line in the sand and get excluded from the process, because either way, physicians will have to work within the system that gets created.
"It appears that change is probably going to happen," she said. "The important thing for us is that we are part of the solution. If we are on the outside looking in and just complaining without being pat of the solution, that's not a good place for physicians to be."
She said that Daschle reached out to the AMA shortly after the election, and the group expects to be involved as a plan gets hashed out.
"That's a better way than to cross your arms and say 'no' 100 times," she said. "Then nobody talks to you anymore."
The AMA may speak up at times to point out potential unintended consequences from some ideas, she explained, but it doesn't want to be an obstacle to reform.
I asked her specifically about Daschle's idea of a Federal Health Board, modeled after the Federal Reserve Board, which I criticized in my article on the main site today.
"It's a very interesting approach," she said. "I wouldn't immediately react negatively to it at all."
But she made clear that she'd have to know how it would take shape, and her ultimate opinion "would depend on the scope of the board."
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st. louie mo| 12.12.08 @ 9:49AM
Sometimes saying NO a hundred times is still a good option when the plans presented to your a C**P.
With that said I agree it appears "reform" is inevitable in light of our 46 million uninsured illegals and collegiate yuppies.
Michael W. Dooley| 12.12.08 @ 10:55AM
I can't speak for Nancy Nielsen; but when HilraryCare was said to be "inevitable" all sorts of Doctors and Nurses were positioning themselves to get in on the ground floor for any new federal department of medicine. As the saying goes, they went into medicine to do good and now they want to do well.
On the other hand, most doctors and hospitals carry a substancial burden of "bad debt"--that is, services, supplies and time they have given for which they will never get paid because the patient cannot or will not pay. Many are giving into "reform" thinking they'll at least get paid "something" instead of nothing. Yet, healthcare provider who has to deal with medicare knows that the government doesn't bargin with you. Instead, IT will tell you what treatment will be paid for according to diagnosis, what you can charge, what they decide to pay you, and when you might expect to get the check provided you've towed the line on some other things.
Not to worry, though. I'm sure no government official will actually even dream of telling your doctor how to practice medicine.
ottovbvs| 12.12.08 @ 4:44PM
There are a couple of posts from Klein on this subject and I've commented on the other so I'll say a word about this.
Firstly, can we get one thing straight. The delivery system for healthcare in this country is going to remain overwhelmingly in private hands. What's being talked about is how it is paid for and as Klein says elsewhere the endgame is a single payer system. And whether anyone wants to be grown up enought to admit it, the fact is that when it comes to disbursing the funds this is by far the most cost efficient because it substitutes one set of rules for dozens of different sets of rules.
Which brings us to the next boogey man, namely the notion that some bureaucrat will be wielding the scalpel. You can tell the people who say this have never experienced the current system in any serious way because the amount of oversight currently exercised by insurance companies is onerous to put it mildly. Just ask any doctor. I remember a couple of years ago having a huge argument with my insurance company because I had stayed a day longer in hospital than they had deemed appropriate for the procedure. No matter that the doctor wouldn't let me leave they decided. It took months to resolve.
What we're going to get is Hillary and Romney's (before he disowned it) health plan. Mandated universal insurance with a cheap govt insurer for those that can't afford the company premiums. The insurance companies won't be able to reject for pre-existing conditions and are not going to make as much money but if they want to stay in the business they'll have to cut premiums or they'll be squeezed out. In other words the market is working as it should.
This whole subject is so loaded with myth and prejudice that I really think conservatives have lost the ability to look at it with objective eyes. David Frum said something I remember.
James Hovland| 12.12.08 @ 5:32PM
The insurance companies plan for their universal profit, is exactly the kind of government control we don't want. The insurance companies are wasting our money and corrupting our system. If you have insurance, you pay for lobbyists, political contributions, and anti-government propaganda. These are just a few of the unhealthy expenses that are include in the high price of health care.
We can keep our doctors and hospitals in the free market and still have 'National Single Payer Health Care'. The insurance companies can not be trusted anymore. Insurance is not health care, doctors and hospitals are. Let's keep our money where it actually benefits our health.
John| 12.13.08 @ 8:32AM
Single Payer Helath Care is the only solution. Even the Prescription Plans are heavily regualted by the Insurance Industry. Again, we are being sold black and white arguments by mental midgets based on presuppositions motivated by protecting their individual life styles. The insurance companies need the premiums to invest. All of god's children deserve health care. I owned a business for the last four years and could not get health insurance for less then $14,000.00 per year and it would not cover my high blood pressure medicine ($500.00 per year).
I now work for a Fortune 500 C0mpany and the premium they pay including my contribution is $6000.00 per year and they cover my blood pressure medicine but only after forcing my doctor to change my prescription which does not control the blood pressure as well.
The decision to close my business was due partly to the housing economic downturn and the issue of "No Health Insurance". The insurance companies, doctors, hospitals, and even some tax-payer funded emergency services charge higher rates for those not insured compared to those who have insurance. That's fair. This alone creates a tariff on every small to medium sized business. It is designed to create an unfair advantage for large corporations.
The current health care system is a detriment to small and medium size business. I want to pay the same rate that GM pays. that is what we are really talking about. Addtionally, Adam Smith the founder of Capitalism would not even recognize this aboration we call "free market" concerning Health Care. He would have set it up at regional or local levels with federal guidelines.
We conservatives need to look at the facts and our history and work for federal guidelines of regionally controlled systems. The insurance companies deserve to be booted out. They have taken advantage of everyone for far too long.
Edward J. Volpintesta MD| 12.13.08 @ 8:36AM
The serious shortage of primary care doctors is a big part of the health care problem. They could be turned out quicker if their training were reasonably shortened. This could be accomplished by tailoring it to their real-world needs.
What does this mean?
Most doctors whether specialists or general practitioners undergo in their college and medical school years the same intensive focus on basic sciences. It includes subjects like organic chemistry, physics, calculus, biochemistry, physical chemistry and others. The contents of these subjects are rarely, if ever, needed by primary care doctors.
By adjusting the curriculum to the needs of primary care doctors, at least three years could be cut off from the traditional eleven needed to produce a general practitioner.
American medical education is, and has been, for most of the past one hundred years geared to scientific research and specialization, the blessings of which we are all recipients of.
However, the orientation to research and specialization has created a steadily growing indifference towards primary care. The result is an acute shortage of primary care doctors. So much so that it will be necessary to use nurse practitioners and physician assistants to help fill the demand. This will become more obvious once universal health care becomes enacted.
Shortening and customizing the training of primary care doctors won’t solve the problem immediately but it is a start and will eventually put balance into the health system.
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