Doc Fight: Physicians Attack AMA's Support for Healthcare Reform
The medical profession, like the rest of the country, vacillates between narrow self-interest and broader social concerns in its attitudes toward healthcare reform. The leadership of the American Medical Association, despite some waffling before the vote, has held to its support for the reform legislation, largely because it expands coverage and gives patients some protections from rapacious insurance companies. But some of its state-level members are getting restless.
A recent letter to the AMA from the Florida Medical Association (FMA), first reported by The Hill, says that because the AMA didn't insist that Congress include malpractice reform in the Affordable Care Act or craft a "better" reform bill, the Florida association has lost confidence in the national organization. In fact, the FMA says, its governing body nearly voted to withdraw from the AMA over the issue.
Up to now, doctors' main problem with reform has been Congress' unwillingness to eliminate Medicare's current payment methodology and to guarantee that physician reimbursement -- now scheduled for a 23 percent cut in December -- will be increased, not reduced, in perpetuity. According to the latest Congressional Budget Office estimate, such a move would cost the government $330 billion over the next 10 years, so it's not likely to happen.
Apparently realizing that this is not an option, the FMA is pressing the AMA to step up its campaign for a pending House bill that would let physicians contract directly with Medicare patients without any restriction on their charges. The AMA has long supported such legislation, which would essentially allow doctors who do not participate in Medicare to "balance bill" seniors for any charges in excess of what Medicare is willing to pay. Today, they can charge a bit more than what Medicare allows; but under this bill, the sky would be the limit.
If Congress passed the measure, of course, it's likely that most doctors would drop out of Medicare and just start charging whatever they wanted. But that's not going to happen, either, because seniors would cry bloody murder -- and for good reason.
The FMA position on reform is not unusual among state medical societies. In December 2009, as the reform debate was nearing its zenith, a coalition of ten state medical associations and six specialty societies sent Sen. Majority Leader Harry Reid a letter lambasting the reform bill in language that sounds like it was drafted by the Republican National Committee. The letter talked about undermining the patient-doctor relationship, giving the federal government too much authority, setting the U.S. on the road to a single-payer system, and so on.
Among the signers were the medical societies of Alabama, Delaware, Florida (naturally), Georgia, Louisiana, Missouri, Nebraska, New Jersey, and South Carolina, as well as the District of Columbia. The specialty societies all represented surgeons.
Despite the physicians' complaints about a government takeover, what they're really concerned about is how much they're going to be paid. And on this issue, many doctors feel that the AMA leadership let them down during the negotiations over reform. I recently asked Dr. Peter Carmel, a New Jersey neurosurgeon who is president-elect of the AMA, about that, and here's what he said:
You would think that for the support the AMA gave [on reform], there might well have been some consideration given to [fixing Medicare payments to doctors] by the Administration and by the Congress. But in fact, the price hedgehogs got into it and said, 'Oh, healthcare reform is too expensive.'...The Administration has made a number of attempts to get [the issue] back on the table, but has never been able to convince any Republicans -- although the Republicans have long opposed the [Medicare payment] formula -- to vote for it. They couldn't even convince a number of Blue Dog Democrats.
So there it is, from the horse's mouth: Hundreds of thousands of doctors who lined up with the Republicans against healthcare reform have not been able to get what they want because of... Republicans. You can laugh or you can cry, but that's American politics.
Image supplied courtesy of Wikimedia Commons.
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