Physicians

POLICY/PHYSICIANS: More on the AMA

So why did I get so grumpy with the secretary of the AMA and his talk at TEPR. I actually stood up and asked a long question which he interrupted to tell a bunch of lies about Canada, ignoring that there are lots of other countries with universal health care that do it differently and better. When I finally got to ask about why when ePrescribing was originally mandated for Part B in the house version of the 2003 MMA eRx legislation and ask as to why it mysteriously was left out of the final bill, and what was the AMA’s role in that — well as Neil Versel said to me afterwards “no one dodges the question like the AMA.”

Things he featured prominently………………The uninsurance crisis and how tough that is for doctorsThings he didn’t mention……………………The AMA’s long, long history of opposing universal health insurance including 1994

Things he featured prominently………………The AMA’s proposal for tax credits for the uninsuredThings he didn’t mention……………………That those proposals do almost nothing to reduce uninsurance

Things he featured prominently……………….How Pay for Performance was unfair on doctorsThings he didn’t mention……………………The AMA’s long, long history of opposing quality improvement

Things he featured prominently……………….How Medicare pay rates have fallen by half over timeThings he didn’t mention……………………The vast real increase in physician incomes since 1965

Things he featured prominently……………….How physicians will drop Medicare patients if fees go downThings he didn’t mention……………………The research that shows that this is untrue and an empty threat

Things he featured prominently……………….How other countries government’s paid for doctors’ ITThings he didn’t mention……………………How other countries doctors earn much less than him and his colleagues

Things he featured prominently……………….How the government should pay for physician IT but not mandate its useThings he didn’t mention……………………Every other business has been force to get IT to better serve its customers

Things he featured prominently……………….How Canada has rationing and is going to allow some private medicineThings he didn’t mention……………………That low–middle income Canadians don’t go bankrupt from the cost of health care

Yup, apparently it is just everyone else’s fault and physicians have no need to change anything.

I am on record as wanting doctors to run our health care system. I want physician organizations to get the money and decide its rational allocation . But apparently organized medicine’s response is to bury its head in the sand and demand that the rest of us hand them a blank check, and let’s all pretend it’s 1972 again.

Please please someone tell me that this guy is an anachronism and that he really doesn’t represent physician opinion….or else I will get even more depressed…

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Tom LeithTomHScott Robertsonjack danielsMatt S. Recent comment authors
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Matt S.
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Matt S.

Tom L: Agreed and perfectly phrased.
TomH: Great response. But I promise, it’s not “cheap demagoguery.” It’s actually terribly expensive demagoguery. Tongue-in-cheek, but even so.
Scott: Thanks, I appreciate the praise and constructive criticism.

Scott Robertson
Guest

Matt S. –
I agree that I am splitting hairs, but the devil is always in the details. Your rebuttal is good.
I cringe whenever the AMA is quoted in any fashion because I just don’t accept them as an expert source in anything. They have very little credibility with me because they only represent a minority of practicing physicians.

TomH
Guest
TomH

Much appreciate the references regarding senior wealth. Here are the basic issues. 1. Seniors have more household wealth than younger Americans. Most of the disparity, though not all, is due to home equity. Here’s the relevant numbers on median net worth from the Census Bureau report that Tom Leith cites: 75+ 19,025 70-74 31,400 65-69 27,588 55-64 32,304 45-54 23,525 35-44 13,100 -35 3,300 2. The Census Bureau notes that excluding home equity when comparing net worth is important “for households with retired householders.” That’s because the householder pays property taxes on a sharply reduced income. And the equity cannot… Read more »

Tom Leith
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Tom Leith

> Medicare recipients have twice the > net wealth of people under 65? Source please. US Census Bureau. The statement is true enough even if we exclude home equity, which there is no reason on earth to do. We have such friction-free capital markets here that the equity in one’s home may be converted to cash, in full or in part, with a few simple strokes of a pen. To say that home equity is not “liquid” is just silly. > the elderly are far less poor[…] thanks to > social security and medicare Just because somebody gives you something… Read more »

Matt S.
Guest
Matt S.

[Ah, Jack Daniels. We meet again. And I see you’ve brought your trusty sidekick, Random Capitalization. Gentlemen: a pleasure. As for you, Random Caps, I’m just going to call you Rocks n’ Coke from now on, since you and Jack seem to go together so naturally. Seriously, Jack, I kid. But next time, hold the Rocks n’ Coke.] — Jack, I didn’t say that every doctor was in the AMA. I said that the views of the AMA were more representative than most people think. I know this from experience in my job. In addition, simply because 70% of doctors… Read more »

TomH
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TomH

Hmm. Medicare recipients have twice the net wealth of people under 65? Source please. And let’s exclude home value, since that’s not a liquid asset.
I wouldn’t mind seeing a comparison of non-public income between the elderly and the non-elderly. My recollection is that the elderly are far less poor than they once were, thanks to social security and medicare, but still poorer than the American population as a whole.
It’s not as if the U.S. passed Medicare because the AARP asked for it. It’s just as close as the AMA would let us get to universal health coverage in 1965.

Scott Robertson
Guest

I do not belong to the AMA – never have, never will.
Matt S. – you may think (loud and clear) that the AMA is a labor union, but you may need to re-educate yourself on labor relations, collective bargaining, mandated membership rules, etc. There cannot be a “union” if the members cannot collectively bargin with payors.
The AMA is a trade organization/political action committee – no more, no less – that represents fewer than 1/3 of physicians in the U.S. – very few clinicians care or support anything that the AMA has to say.

Matt S.
Guest
Matt S.

Just to clarify: Medicare for all is something I’m not for. But getting us all into one risk pool is something I do entertain.

jack daniels
Guest
jack daniels

Guys get a grip. The AMA recently “boasted” that just UNDER 30% OF ALL DOCTORS WERE MEMBERS, thats after a massive membership drive. 70% of all doctors have NOTHING to do with the AMA. Lets quit pretending that the AMA is some vast mighty force with a lot of clout on capitol hill. If you ranked the dominant lobby groups in Washington DC, the AMA would not even make the top 50. If you ranked the AMA among healthcare lobbying organizations, they would not be in the top 10. Medical malpractice TRIAL LAWYERS have more lobbyists and funding in DC… Read more »

Matt S.
Guest
Matt S.

Mr. Holt, Sadly, your analysis hits the nail on the head. Just to say it again, loud and clear: the AMA is can be approximated as a skilled labor union, using any and all influence to achieve better outcomes for members at the expense of non-members. I can tell you that from my experience on the negotiation/insurance side, everything the AMA secretary said is much more representative than most people believe. Not all doctors are like this (and thank goodness for them), but many physician’s views are just as simple and polarized, show a shameful resistance to all attempts at… Read more »

Eric Novack
Guest

Let’s focus on the medicare issue. It is a presumed ‘given’ that the solution for universal coverage for many means medicare for all. I am on record, and maintain, that the passage of the medicare legislation CREATED the current health care crisis. Also, as I have written here before, medicare is not a monolithic system, but rather THREE different systems (Part A, B, and D). This has to do with funding streams and rules. The magic of LBJ in 1965 was to pass legislation to please everyone. If you must focus on doctors, the charge whatever and get paid for… Read more »