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Some Docs Upset at AMA's Public Plan Stance

Cheryl Clark, for HealthLeaders Media, June 16, 2009

When David Priver, MD, once an American Medical Association delegate, read last week that the group opposed President Barack Obama's public insurance plan option for adults under age 65, he blasted an angry e-mail to his colleagues:

". . . If nothing is done to reverse this ill-advised AMA policy, we can expect (AMA) membership to drop like a stone," wrote the San Diego obstetrician-gynecologist.

Even when learning the AMA backed off from that stance the next day, clarifying that it merely opposed any plan that forces physicians to participate or which pays Medicare rates which are too low, Priver was not appeased.

"Why make a statement like that and backtrack a day later?" Priver rhetorically asked in an interview Monday, saying he thought the move was disingenuous. "I think they really shot themselves in the foot this time."

For many physicians across the country, the AMA's initial stance severed any allegiance doctors have for the nation's largest and most powerful physicians group.

"The AMA has badly misread the sentiments of not only its members, but of physicians across the country," says Priver, former president of the San Diego County Medical Society and delegate to the California Medical Association. "Most of us don't want to be seen as obstructionists for reform. And the AMA, if they did a better job of keeping in touch with the grassroots, would have known that," Priver says.

Priver joins an increasingly vocal group of doctors who say they are defecting from the AMA.

In an article last week entitled "Dear AMA, I Quit!" in the Huffington Post, a Maryland physician said he was "disgusted" that the organization seems pre-occupied with physician reimbursement at the expense of patient care. Instead of working for patients, it seems to be "supporting the private insurance industry, which has been a driving force in creating the dysfunction(al) health care system we have today," wrote Chris McCoy, MD.

McCoy said he was reacting not just to the Thursday article in the New York Times, but also to the AMA's 12 pages of comments on health reform submitted May 11 to the Senate Finance Committee. Such a plan "threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70% of Americans," the AMA wrote.

"A crowd-out of private insurers and the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers," according to the AMA.

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5 comments on "Some Docs Upset at AMA's Public Plan Stance"


DrJJ (8/20/2009 at 1:07 PM)
Why would any rational physician expect the AMA to support a healthcare reform proposal which does nothing to reform the medical malpractice mess? I commend the AMA for having the courage to speak up against this popular but slippery and disingenuous presidential administration.

Rob (6/18/2009 at 4:38 PM)
Where is the healthcare reform debate going? We started with concern about access for the uninsured, quality, and cost control. Now the governmnet spotlight seems to have shifted to a government sponsored health plan with no thought as to how to effectively control cost or cover the uninsured or pay for the program. Changing the "insurer" will not of itself control cost. It is time for health systems and their physicians to come together through cinical integration to achieve the new expectations of access, quality, and cost effectiveness. Cost is multifacted. It is related to the long held expectations of consumers to have access to anything and everything without cost to themselves, to the fact that healthcare services are provided by independent provider practices who are paid for what they do not what they save, and to a large number of for-profit companies involved in healthcare directly including hospitals and indirectly such as insurers, pharmaceutical companies, and technology companies, and to the rampant waste in healthcare. Currently providers toil to provide excellence in healthcare and achieve success for their own practice. There has been no expectation on the part of patients or government or anyone else that these providers be cost-effective. There has been an expectation that providers will do everything possible when someone faces minor or major illness. There has been an expectation that companies will develop new medical technology, will produce more pharmaceutical agents to combat illness, that communities will have hospitals even when they are small and not cost-effective, and that even very specialized care will be locally available regardless of ultimate cost. Where we are is where we should have expected to be - in the midst of costly healthcare largely aimed at treatment rather than wellness where obesity, cigarette smoking, and lack of exercise abound even in those who actually do have wellness coverage. The current state of healthcare is analogous to the automobile industry. Buyers' expectations have been larger vehicles, faster vehicles, attractive vehicles, and SUVs with no regard for fuel efficiency or alternative energy to power the vehicles. And, Detroit gladly responded to our expectations. Then reality struck. There is no organizational structure in our world of healthcare to respond quickly and effectively to a change in expectations. And, there is no one in our federal government who understands the real word of healthcare. Recently reported approaches of dealing with situations by declaring crisis, dismissing corporate executives, publicly denouncing investors, and controlling banks and automobile manufacturers, suggest the unorganized world of healthcare providers will be dealt with much more harshly. Regardless of one's persuasion and social leanings, healthcare providers and their communities MUST become proactive in healthcare planning and we need to achieve reform now. Yes, expectations are changing. Yes, we need cost-effectiveness, we need high quality clinical care, we need ever evolving technology and therapeutics, we need access. We do not need control of healthcare reform by individuals with no knowledge of medicine. Let's not confuse finding means to assure access to healthcare for the uninsured and to achieve cost effectiveness with a need to turn to governmental control of healthcare. Health systems and their providers can come together through cinical integration to achieve the new expectations. Like all good endeavors it will take time. But, we can and must achieve success. RVC

Gary (6/17/2009 at 4:13 PM)
Private health insurance costs continue to rise, while their contracted reimbursements continue to fall... hospitals are giving away 10 - 20% of their revenue to unreimbursed care, and that number (% of unreimbursed care) is increasing. For those of us who have insurance our out-of-pocket expenses have continued to dramatically rise - and the number of uninsured and underinsured is going to significantly increase in this economic environment. Do the math some reimbursement on all of your patients is better than something on some of them. The current healthcare picture is in crisis and getting worse - i think its time medical providers and US businesses did the math, and dramatically changed our failing healthcare system... and as much as i hate to admit it, the most cost-effective business model is a single payer system - with fixed/fair reimbursements (somewhat weighted to geography, outcomes and effectiveness), which eliminates all the middle-men AND the need for providers to negotiate managed care rates with private payers that are constantly pushing for lower contracted rates and processing lower reimbursements and more denials. Main problem with the above - the insurance industry and pharmaceutical industry own a/o operate congress.