AAPS Membership May be Liability for Price, Says Group's Leader

The Association of American Physicians and Surgeons counts Tom Price, MD, the nominee for HHS Secretary, as a member. The group's agenda calls for a phase-out of Medicare.

When President-elect Donald Trump last week nominated U.S. Rep Tom Price, (R-GA,) an orthopedic surgeon, to serve as secretary of Health and Human Services, media focus turned to the Association of American Physicians and Surgeons, a self-described non-partisan group that espouses the merits of " individual liberty, personal responsibility, limited government" and calls for the phase out of Medicare and greater autonomy for physicians.

HealthLeaders Media spoke this week with Jane M. Orient, MD, executive director of Tucson, AZ-based AAPS and a general internist. The following is a lightly edited transcript.

Physicians Split on Price HHS Nomination

HLM: Describe AAPS.

Orient: We were founded in 1943 and we promote independent private medicine. We are opposed to socialized medicine, which means a government takeover or government intrusion into medical care dictating what you can and cannot have, what you must pay for and what you can't pay for, and that sort of thing.

We believe physicians should be working for the patients and not the government or a third party because they have the control over their paycheck.

We really believe in freedom of expression and thought. We don't believe in setting up a scientific dogma that this is what you have to believe.

You are not allowed to raise questions about certain areas, because there are so many uncertainties and so many unknowns if we try to gag people and say if you raise a suggestion that is not in the mainstream you deserve to be gagged or ostracized. We need freedom of thought.

HLM: What is your membership?

Orient: Approximately 5,000, all over the country, all specialties.

HLM: Is Dr. Price a member of AAPS?

Orient: He's a member. He's spoken at our meeting. We in general agree with his philosophy, although not with every detail he has proposed.

HLM: Why do you support Dr. Price's nomination?

Orient: We think he is a good man. He's certainly well qualified. He has a first-hand understanding of the impact that government regulation has out in the real world. He generally has a philosophy of freedom and supports the right to practice independent medicine.

HLM: In what areas do you disagree with Dr. Price?

Orient: Republican plans have this idea of refundable tax credits, which in our opinion is the same thing as a subsidy and being deprived of a credit is the same thing as a penalty or a mandate.

It gives the federal government the power to define what constitutes an acceptable or qualified insurance plan to enable you to get the tax credit.

We can have some discussions about the details, but we would agree with him that Obamacare needs to be repealed. We don't even know yet what all is in it, but it has created a real maze of complexity and interactions and taxes and mandates and so on.

HLM: Is AAPS libertarian-leaning?

Orient: We've been called conservative. We've been called libertarian. Generally, we believe in constitutionally limited government; interpreting the constitution the way it was written, which means that Congress has certain enumerated powers and other things should be left to the states. That would include the regulation of insurance and the practice of medicine.

HLLM: Would AAPS like to see Medicare and Medicaid abolished?

Orient: We would like to see them phased out. There is no way you can abolish them suddenly because you have so many people utterly dependent upon them. But we need to rethink the whole structure of the program, which was enacted under false pretenses to fund Social Security.

Seniors believe they have paid for their care through these "contributions" they had to make while they were working, but in fact it's not a right all. There is no contractual right to get anything out of it. It's an entitlement. It's a privilege.

And all of the money we put into it is gone immediately to pay for other people's medical care or if there is a surplus to pay for whatever else the government wants to spend it on.

The Social Security trust fund is a fiction. It's just indebtedness for what the government has taken from the payroll tax to buy other things, from aircraft carriers to food stamps, or anything to reduce the size of the deficit.

HLM: Without Medicare, how could healthcare be affordable for senior citizens?

Orient: First of all, we ought to allow people who want to get out to get out. Like me, I want to get out. But, if I claim my Social Security, I have to be on Medicare Part A, so I haven't claimed it yet.

These two things should not be tied together. We need to allow people to do that without paying back any Social Security they've ever gotten or renouncing it in the future. That way, a private market for catastrophic insurance could develop.

You can turn down Medicare Part B, although there is a penalty if you want to re-enroll. My mother just got a bill. Her premium has practically doubled, it's gone up by $199 per month this year, and that is a consequence of the Affordable Care Act that people aren't aware of.

That is $6,000 a year. You [could] buy a whole lot of physician care, which is what Part B covers, if you had that $6,000.

Whereas if it is under Medicare Part B, you get only what the government decides is necessary and prudent and you can only get it at the price the government agrees to pay, which is often not enough to get you some real time with your doctor.

HLM: How would you address concerns that premiums would be unaffordable without subsidies for many seniors, who would otherwise face catastrophic medical bills?

Orient: First of all, we have to look at why that bill is that high. That bill is escalating. It doubled or tripled immediately after Medicare went into effect in 1965. Before 1965 maybe half of seniors didn't have health insurance, and medical care was maybe half as expensive.

Funneling all this through a third party introduces tremendous fraud and waste and increases prices because checks and balances are dismantled. You no longer have customers deciding whether to part with their own money.

They will take what you give them as long as it's free, but if they have to pay $20 for it they might not think it's worth it.

HLM: How long would it take to phase out Medicare?

Orient: I don't know. We need to let people get out as quickly as they want to. What is going to happen, it's just kind of the handwriting on the wall, is that Medicare truly is bankrupt. It is already spending a lot more than it is taking in, and the demographics are terrible.

We are going to have fewer than three working people supporting one retiree. How can three people who are struggling to support their own families and whose wages have been really frozen for quite a long time, or who can't get a good fulltime job, how are they supposed to support all these retired people?

Already we are curtailing what we pay to doctors and hospitals and the value-based system is really a system for rationing care. You spend too much and we aren't going to pay you. The system is like any Ponzi scheme. When you run out of new subscribers something bad is going to happen.

HLM: What other issues are important to AAPS members?

Orient: A lot of it has to do with Medicare and managed care and trying to undo the effect of Medicare on escalating costs, which is imposing a lot of practice guidelines that are intended to control costs but which dictate what physicians can and cannot do.

Of course, the guideline writers have huge conflicts of interest with the pharmaceutical industry and others. The market is so distorted by government rules and mandates and price controls that it is hard for people to imagine what freedom looks like. They don't have a memory extending back to 1950.

HLM: Do you take an issue on abortion?

Orient: We have a resolution on the record from quite a few years ago supporting the sanctity of human life from conception to natural death. We have not been active in deciding what the government should do about abortion, but the oath of Hippocrates is quite clear on that point: Doctors are healers not killers. They do not give women means to procure abortion.

That doesn't say what our members may or may not believe on whether women have the right to get an abortion. But it's clear that the Hippocratic physician doesn't do abortion.

HLM: Is it a fair criticism to say that AAPS is not in the mainstream?

Orient: I guess it depends partly on what you mean by the mainstream. The majority of people in this country are in a state of deep denial about the fiscal realities of our situation.

HLM: Will Dr. Price's membership in your group be a liability for him in the nomination process?

Orient: It's going to be a liability for him on some fronts because a lot of people don't agree with us about limited government or the desirability of independent private practice.

But it should help on other fronts. The people who do agree with us might think it's a point of pride.