How The AMA Is Playing Healthcare Reform

Have you seen the new American Medical Association ads supporting healthcare reform? I'm referring to the ones in which an AMA spokesman notes that certain regions of the country have only one or two health insurers and suggests that if they had more competition, health costs would come down. The ads also specifically support a public option.

An innocent viewer might think that the AMA had fundamentally changed its position over the years. For many decades, the medical association fought any kind of reform that would increase government intervention in health care. And the right wing has called the public option the beginning of a government takeover of healthcare-the very type of "socialism" that the AMA always warned us about.

But while the AMA has conceded the inevitability of reform, it is trying to shape it to advance doctors' goals. Take insurance competition. For the past several years, the association has been publishing the results of surveys that show there are progressively fewer health plans in each market-and in some markets, only one plan dominates. That can be a problem for employers and consumers, but it's an even bigger threat to physicians, who have less ability to bargain with very large plans. So anything that will boost competition among insurers is good news to physicians.

How about the public option? Let's start with the fact that most physicians hate insurance companies, which restrict their access to patients and try to influence how they practice. So from their viewpoint, a public plan patterned after Medicare would be a step in the right direction, because it would include all willing providers and would not manage care. (Medicare does deny more claims than private plans do, but that's another story.) Not surprisingly, a majority of physicians support the public option, and so does the AMA.

But that's just part of the AMA strategy. As AMA leaders have made abundantly clear, they would not favor a public plan that paid Medicare rates and required physicians to participate in it as a condition of Medicare participation. In fact, AMA President James J. Rohack, MD, recently boasted that the AMA had helped defeat an amendment to the Senate Finance Committee bill that would have created a government plan with both of those features.

As things stand now in Congress, a public option is starting to look more likely to be included in the final legislation. But the final House measure will probably not encompass a public plan that pays Medicare rates, and the Senate version will likely be even weaker. And none of the bills currently on the table would require doctors to participate in anything.

So the AMA figures it has nothing to lose by defending the public option. If it passes, the government may set up plans that will compete with private insurers all over the country. If these public plans have to negotiate with doctors on rates, the physicians will be in a better position with the private carriers as well. Of course, health care might cost more as a result.

If you think this is a fanciful reading, consider that the AMA's number one priority throughout the healthcare debate has been to "fix" the Medicare payment formula that threatens to chop Medicare reimbursement of doctors by 21 percent this year and more later on. Of course, that doesn't mean replacing the formula with something that will get costs under control in the long term. No, it means throwing it out entirely so that doctors will continue to get paid more when they do more.

The bottom line: Physicians, like every other player in the healthcare realm, are fighting for their own advantage, first and foremost.