Obama vs Hillary at the AMA

Sixteen years and two days after then-First Lady and Health Care Czar Hillary Clinton went before the American Medical Association’s House of Delegates to sell her vision of national reform, President Barack Obama is treading the same path. I’m not sure how much greater eventual success Obama will have with the AMA, but having covered the Clinton speech as a reporter for the Chicago Tribune, I have three lingering memories.

The first was the invocation given before Clinton arrived. Its gist was, “Oh, Lord, you have taught us it is impolite to boo our guests, particularly in front of hordes of reporters.” The second memory was that Clinton finished her speech to a standing ovation. And the third is that she spoke fluently and passionately for 50 minutes without a prepared text, much to the chagrin of a national press corps accustomed to being spoon-fed a follow-along text before filing their stories. Fortunately, being a mere “regional reporter” (as the White House called us), I had taken notes.

Obama’s visit promises at least a few contrasts. He runs virtually no risk of being booed. He’s not only the President of the United States, and a very popular one, he’s also a president who has eschewed the perceived doctor-bashing engaged in at times by President and Mrs. Clinton. Obama most assuredly will not be speaking from notes, being as attached to the teleprompter as Ronald Reagan was to his 3×5 cards, but in the Internet Age anyone who cares to will be able to hear him live, anyway. A standing ovation? We’ll have to see.

To the amazement of her audience in 1993, Hillary went out of her way to hit all their hot buttons. For example, she praised the doctor-patient relationship and lashed out at the “excessive oversight” of insurance company reviewers and government bureaucrats who second-guess medical decisions. She talked sympathetically of the need for reforming malpractice laws and amending antitrust laws to allow medical professional societies to discipline poor-quality doctors on their own. (Here, I’m relying on a copy of my story I grabbed from an electronic archive.)

Obama, by contrast, prides himself on seasoning the obligatory political pandering with a soupcon or two of hard, cold reality. While reducing red tape and the need for defensive medicine are sure to be high on his list of promises, I don’t think he’ll hesitate to invoke the harsh global economic challenges that make health care reform so urgent. Look for Obama to remind the doctors how many more uninsured patients they’re seeing today and how much more involved Medicare has become in setting doctor pay scales.

One more contrast: in 1993, the AMA shoved forward Nancy Dickey, the one woman on their nine-person executive committee, to be its public face during the Hillary visit. Today, the organization’s elected president is Nancy Nielsen, the second woman to head the group (Dickey went on to the top job) and, though not publicized, the first who came to the post after holding a senior position in one of those dread health plans.

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16 replies »

  1. Malta – I only wish I would have come across your post sooner so I could have earlier told you how completely wrong you are – in fact 90%+ of what you write is BS and you are simply WRONG – not opinion – this is fact and allow me to clarify for everyone’s benefit…
    1) You say that health care is a privilege and not a right as guaranteed by the Constitution – well then, what about privacy? This is not explicitly stated as a right in the Constitution however we all enjoy a liberal and free society in large due to our “right” to privacy. Are you saying you feel that privacy is a privilege? Are you willing to let the cops come to your house to search whenever they wish? Are you willing to let them walk into your bedroom to check to see what you’re doing – this ok with you? Not me chief – NEVER!!!
    2) Most folks who are offered health care at work DO NOT opt to pay their own way- this is 100% incorrect – most folks, well over 85% choose some form of coverage when offered through their employer.
    3) Most folks – and I’m sure you are included – DO NOT PAY THEIR OWN WAY. Just because someone pays some pittily premium at work or through some other plan does not mean you pay your own way. With only very minor exceptions, health care ALWAYS costs more than the premiums you fork out. This obviously varies depending on the person but in most cases, your health care bills will always be more than what you pay out. If not, then nobody would need coverage – it’s commom sense. And in fact, ALL insurance is based on the majority pay for the miniory rule – the basic precept that the majority of the folks are NOT in need so their premiums go to pay for the minority who do need service – otherwise, there would be no insurance industry.
    4) Have you researched and studied the national health care systems in any of the Countries in Europe or Canada? It’s a rhetorical question because based on your comments, it’s clear you haven’t – go read and talk to some foks – not one or two BUT SEVERAL – and you will find most are quite happy with their care. Is it as good as in the US? In some ways yes and others no but the answer lies in us taking what’s good about our system, marry it with what works abroad, and then move forward with that recipe – not rocket science.
    5) You railed against Joe Biden about some of his comments (which are not verifiable) and for his health coverage but REMEMBER THIS – ALL OF CONGRESS has the exact same set of health care options – not just the Dems – and I have yet to see a single GOP’er out there state they will cut thier care until we get a better system for all. They’re all hypocrits – not just the Dems – and also remember who screwed the pooch in regard to the fiscal situation – not the Dems my friend – go and research who voted where for the finanical refoms of the last 25 years and you will find it heavily laden with the right-wing vote.
    6) Your rally cry is that the whole cost mess is due to coverage for illegal imigrants – what comeplte BS – where did you get this stat??? If you think that the majority of health care costs are for illegals then you are truly an idiot. The only way an illegal immigrant can even get some type of free medical procedure is if they go the the ER AND they are in a life threatening sitation. Otherwise, it would not be paid OR they would be on a covered plan which means they are paying premiums. Additionally, this number is still quite low because most workers who pay into a health care plan (like over 90%) are documented and legal workers.
    This is a moral issue – put another way, is it morally acceptable that some folks – based on simply circumstance – are not able to gain access to even basic health care? Or yet another way, is it morally acceptable to be in finacial or “life” jeopardy due to a loss of health care because your company off-shored your job, had 3-4 rough quarters and layed you off, because you are too old and were replaced with a younger person? Or is it morally acceptable for any human being to ever have to consider finances in regard to a medical procedure that could save thier child’s, spouse’s, grandparent’s, etc. life? And finally, is any of the above morally acceptable in any nation let alone the most weatlhy nation in history of man?
    Where in the hypocratic oath does it discuss finances or costs?
    So try again but next time, please try and get the facts a little more accurate…

  2. If you want to see what will it happen to the health care industry, you might want to look at what it happened to the child care industry in Georgia when the state started to pay for free education for 4 years old. The payments hardy cover the expenses to pay occupancy, supplies and teachers salaries, therefore the additional money used by the program comes from fees paid by infants, twos, and three years old. The school districts refused to carry this program, because it does not pay enough. Most parents refused to pay a fee to take their four years old to a center because they only want it for free, and like all free programs created by the government it does not produce the results desired. Since it is free when it is an incovinience for the parents to drop the child or pick up the child on time, frequently parents keep children at home when is not convinient for them to pick up the child. I can imagine that the free or reduced health care have similar consequences in the industry. The insurance business will disappeared and only and if the government allowes it, it will be availabe for the rich that can afford to pay private insurance or private doctors.

  3. I agree with the Donald’s comments, Obama does not know much about the healthcare indutry; what i feel now is we are on the verge of the medicare disaster.
    It would be the same as we have seen in the real estate industry collapse(2007-08); Or, it might be worst than it as it belongs to the lives of real people.

  4. Malta,
    Great post. Right on.
    Deron S.,
    No, am for radical changes that I’ve blogged on since 2003. Some are noted in my previous post in this thread.
    To summarize:
    Get employers and government out of the health insurance business. They are dishonest players.
    Eliminated states’ some 1,000 mandated benefits. They add some 30% to the cost of health insurance premiums and mostly benefit the providers who sponsor them, not patients.
    Give individuals, not employers, the tax incentives to buy health insurance.
    Let individuals buy insurance that they can easily take with them when they change jobs. This would reduce the number of the uninsured citizens, which is some 6 to 8 million Americans, as I’ve blogged repeatedly. It also would promote job mobility and raise income levels. And it would let individuals buy the policies they want so long as they bought catastrophic coverage that covered them for millions over their lives and involved deductibles and co-pays that they could afford.
    Require community rating instead of medical risk rating by insurers. And require insurers to put all of their insureds into national, regional or state risk pools rather into small groups of low risk insureds.
    All of this could be done without costing consumers or governments a dime, but it wouldn’t create a pay to play system that attracted millions in campaign contributions to the Ted Kennedy’s of the Congress and to presidential candidates.

  5. While health care is extremely important it is not a constitutional mandated-right it is a privilege. Obama and the Democrats want to control our health care. It is their intent to jam socialized health care down our throat and force you/me to pay for others that opt not to pay for their own health care coverage. Many individuals that are offered health-care plans on their jobs are opting out to pay their own way. All of us under a national plan would then be responsible for all those that don’t want to carry their own coverage. Once you are under a national health care program the government then gets to decide what kind of coverage you will get. Should the government take over the health care we will have a health care crisis in that of a health care rationing.
    Every program that the government runs (Medicare, Medicade, Social Security, Fannie Mae, Freddie Mac) are corrupted and are failing terribly. It is Obama/Liberal Democrats intent to tell your physician what, where, when, and how we will receive our health care. Biden has already stated that the elderly will just have to learn to cope with getting old and not get to see the physician as needed. These same politicians will have their own superior and personal health care so that they will not be susceptible to the inefficient health care coverage that they want to put upon us. This is another government program that will go bankrupt. It’s hard to know whether Obama’s health care proposal is really that naive, hypocritical or simply dishonest. To be honest I personally believe it is a combination of all three. Obama keeps saying that it’s a must to control runaway health spending. Rightly so. But it’s the conclusion of many economists and most definitely the medical field professionals that a government controlled program will create just the opposite effect and greatly increase the spending.
    It is also highly exposed that the reason there is such a disaster in the health-care system is the fact that we as a nation are footing the bill for all the illegal aliens. The cost of insurance and the medical cost would be reduced dramatically if the illegals were not afforded the medical coverage at the expense of the legal citizens. It is time that the blame is put where it belongs on the Liberal Democratic Party and Obamanation. Nationalizing the health-care coverage is not the answer.

  6. Donald J. – It sounds to me like you are advocating for something resembling the status quo. Is that a fair statement?

  7. Debra,
    So you’re willing to put millions of restaurant workers and food industry workers out of work just so you can implement your ‘1984’ nanny state scheme and finance Obama’s misguided take over of the health markets? Who’s going to subsidize the unemployed food industry workers? Oh, I know, they’d take stoop labor jobs in the fields and produce organic foods.
    Makes no sense to me.

  8. While all people need access to health care, we have to be able to pay for it. So instead of taxing the rich (who aren’t going to be rich for much longer), how about a “fat tax”? The reasoning is that access to cheap unhealthy food has contributed to the obesity epidemic which in turn has increased the need for health care and driven up costs. So let’s see some real CHANGE and try financing this in a new way by taxing prepared food (restaurants, cookies, ice cream, donuts, etc.) while not taxing unprepared food (meat, vegetables, milk, bread). People can still get food but they would need to cook and perhaps this would help bring about a reduction in Type 2 diabetes, heart failure, cancer, etc.
    Otherwise, this speech looks like Hillary re-packaged.

  9. Michael,
    Like you, I covered Hillary’s campaign for her plan, but I don’t think I covered the speech you did.
    Hillary was honest about her efforts to buy votes by promising almost every special interest what they wanted whether it made sense or not. She published a comprehensive plan that was debated for months before it was defeated.
    I did hear Hillary at an AHA convention that year, I recall how cold and shrill she was. She was no Barack Obama and she still isn’t when it comes to teleprompter speaking.
    I suspect the fact that the gullibles weren’t in love with Hillary affected her ability to sell her very flawed plan.
    There is no question that Hillary knew her brief. Her problem, like Obama’s, was that when it came to health insurance and health care markets and economics, she had started with a clean sheet of paper and it showed. She knew the facts but failed to comprehend their meaning.
    Obama is getting his facts all screwed up and understands only one thing. That is, Obamacare would give him dictatorial power over health care providers and consumers. And that’s all he wants.
    To Obama, patients are peasants with incomprehensible life styles, health care needs and wants and medical complications that he won’t understand until someone in his family needs the freedom to go to the Mayo Clinc, Cleveland Clinc and local specialists.
    Even if Obamacare is enacted, the Obamas will do ok. They’ll play the black and gray markets to get the care and services they need.

  10. Hi, Michael.
    This is one of several blogs I posted today on Obama’s efforts to destroy health care in the U.S.:
    President Obama today tried to pull the wool over the eyes of physicians, nurses, hospital executives and consumers when he spoke before the American Medical Assn. in Chicago.
    He called the health care industry a “ticking time bomb” ready to explode.
    This shows how little he knows about health insurance, health care and health markets, not to mention economics. It also shows he’s willing to create a crisis that he can exploit in his efforts to create a single payer health care system that would hurt all Americans who don’t belong to the political classes.
    Look at the health insurance and health care industries as growth industries that make America rich by keeping Americans relatively healthy.
    When Obama complains about growing expenditures on health care, he shows he’s more concerned about his welfare and power than about patients.
    He’s openly promising to delay and deny care that keeps people comfortable and functional.
    He’s promoting a system that would cause a physician shortage as older physicians retired more quickly than they could be replaced as their pay and freedom to practice as they saw fit were curtailed.
    Physicians are too smart to buy the idea that the public option would be their friend, not their enemy. They’ve lived with the failed Medicare and Medicaid programs for their entire careers.
    Only those who are in denial and want to be fooled by Obama will be.

  11. Jason, I thought the content of the speech was excellent. Having said that, Obama’s approach to Middle East peace, race relations and health care reform all rely on his careful appeals to logic as something that should circumvent emotion.
    Me? I love that approach — as long as it’s backed up with a little raw power to concentrate the mind wonderfully. His speech was balanced and fair. Having 60 Democrats in the Senate may or may not help special interests decide not to try to roll all over him.

  12. I’d really like to know more about your reaction and comparisons after you hear the President’s speech. I hope you will point out that there are physicians like me who do support national health care and want a public option to private insurance. I am a member of the AMA. It does not alway reflect my views. I maintain my membership so that I can try to influence it in support of universal access to health care. I’ve put my “money where my mouth is” and opened a clinic primarily for people who are uninsured. If you need more information about other like minded health care professionals, take a look at the links section of my website http://www.AccessHealthCheyenne.com.

  13. I couldn’t tell from C-SPAN2 whether Obama got a standing ovation, but this speech wasn’t meant for the AMA. It was, in its way, the equivalent of the speech President Bill Clinton gave to a Joint Session of Congress in September, 2003, kicking off his formal reform efforts. So, too, was this speech a kind of health care “State of the Union,” with the AMA allowing him a platform to delve into the kind of detail that would not be appropriate in other places.
    Since the president of the AMA does not run for re-election, I guess Nancy Nielsen’s political fortunes will not be hurt by kissing the president on the cheek when he arrived and when he left.

  14. What I think Obama pulled off with Healthcare Execs…I am not if it was by design or luck – when he had them commit 2 trillion in saving only to retract later.
    That showed the hypocracy of these guys. Hope he might do something similar.
    It is not clear what he is headed for…I hope he ensures that basic insurance is avalaibale to all….Our proposal has been to make basic free by community clinics and then beyond that it could be insurance driven.

  15. Michael: Your coverage of the Hilary encounter with the AMA as a reporter gives you an amazing opportunity to compare and contrast the experiences. The AMA was much more powerful then, has lost most of it membership in the interim, as physicians owe their allegiance to their specialty groups much more than to the AMA. Doctors still command the public’s respect, but I think this is eroding. It certainly is among policy people, as captured in the Atul Gwande piece in the New Yorker, which put a face on the Dartmouth Atlas and Wennberg variations. I’ll be interested in your comments after today. DCK

  16. Proof is in the pudding. Will have to wait and see whether he can change their mind. It is a difficult act.