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American Medical Association Opposes Public Insurance Plan
WASHINGTON - As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan, which President Obama and many other Democrats see as an essential element of legislation to remake the health care system.
The opposition, which comes as Mr. Obama prepares to address the powerful doctors' group on Monday in Chicago, could be a major hurdle for advocates of a public insurance plan. The A.M.A., with about 250,000 members, is America's largest physician organization.
While committed to the goal of affordable health insurance for all, the association had said in a general statement of principles that health services should be "provided through private markets, as they are currently." It is now reacting, for the first time, to specific legislative proposals being drafted by Congress.
In the presidential campaign last year and in a letter to Congress last week, Mr. Obama called for a new "public health insurance option," which he said would compete with private insurers and keep them honest.
Speaker Nancy Pelosi of California said Wednesday that she supported that goal. "A bill will not come out of the House without a public option," she said Wednesday on MSNBC.
But in comments submitted to the Senate Finance Committee, the American Medical Association said: "The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans."
If private insurers are pushed out of the market, the group said, "the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers."
While not the political behemoth it once was, the association probably has more influence than any other group in the health care industry. Lawmakers seek its opinion and support whenever possible. It has repeatedly persuaded Congress to cancel or postpone cuts in Medicare payments to doctors, though it has not secured a "permanent fix."
If the doctors are too aggressive in fighting the public plan, they risk alienating Democrats whose support they need for legislation to increase their Medicare fees.
The group has historically had a strong lobbying operation, supplemented by generous campaign donations. Since the 2000 election cycle, its political action committee has contributed $9.8 million to Congressional candidates, according to data from the Federal Election Commission and the Center for Responsive Politics. Republicans got more than Democrats in the four election cycles before 2008, when 56 percent went to Democrats.
Robert Gibbs, the White House press secretary, said that in his address to the group next week, Mr. Obama would "outline the case for health care reform and make clear why we can't afford to wait another year, or another administration, to bring down costs that are crushing families, businesses and government."
Mr. Gibbs did not say whether Mr. Obama would discuss a public insurance plan, the most contentious issue in the debate.
The A.M.A., an umbrella group for 180 medical societies, does not speak for all doctors. One group, Physicians for a National Health Program, supports a single-payer system of insurance, in which a single public agency would pay for health services, but most care would still be delivered by private doctors and hospitals. In recent years, some doctors have become so fed up with the administrative hassles of private insurance that they are looking for alternatives.
Until now, stakeholders in the health care industry have generally muted their criticism of Democratic proposals. But as details of the legislation have emerged, the criticism has become more pointed.
America's Health Insurance Plans, a lobby for insurers, said Tuesday that the government plan proposed by some Senate Democrats could "dismantle employer-based coverage and significantly increase costs for those who remain in private coverage."
Under a proposal favored by many Democrats, doctors who take Medicare patients would also have to participate in the new public plan. Democrats say that requirement is needed to make sure the public plan can go into business right away with a large network of doctors.
The medical association said it "cannot support any plan design that mandates physician participation." For one thing, it said, "many physicians and providers may not have the capability to accept the influx of new patients that could result from such a mandate."
"In addition," the A.M.A. said, "federal programs traditionally have never required physician or other provider participation, but rather such participation has been on a voluntary basis."
In an interview, Dr. Nancy H. Nielsen, president of the American Medical Association, said she was delighted by Mr. Obama's plan to address the doctors.
"Health care reform is as important to us as it is to him," Dr. Nielsen said. "We will be engaged in discussions in a constructive way. But we absolutely oppose government control of health care decisions or mandatory physician participation in any insurance plan."
Mr. Obama's trip recalls a speech to the A.M.A. in Chicago on June 13, 1993, by Hillary Rodham Clinton. She proposed "a new bargain" in which the White House would limit malpractice lawsuits and free doctors from onerous rules if doctors supported her effort to overhaul the health care system.
The association agrees with Mr. Obama on some points. It says that individuals and families who can afford coverage should be required to obtain it.
Like Mr. Obama, the association wants Congress to cut payments to private Medicare Advantage plans. The White House says Medicare pays the private plans 14 percent more than it would cost the government to care for the same people in traditional Medicare.
Ron Nixon contributed reporting.
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36 Comments so far
Show AllNot too surprising, the canadian docs didn't like the idea of medicare at first either. Some of the brainy idiots still don't like the idea of public health care...
The opinions of the medical extortion cartel (insurance/pharma/AMA) are very predictable.
Private insurance companies' preferred provider paradigm currently limit the choices of all patients. Single payer will not limit choice.
Knowing that a lie repeated three times and left unchallenged becomes a fact, the cartel will continue to claim that single-payer will limit choice, while in fact the cartel is limiting choice and will further limit choice if "health care reform" ends up being a NO INSURANCE COMPANY LEFT BEHIND Program.
"'The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.'
There is absolutely no evidence or logic to support the notion that paitent choice will be any more restricted by single-payer than it is through private insurance.
"'If private insurers are pushed out of the market, the [AMA] said, "the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.'"
Again, there is no historical evidence to support this claim. The taxpayers are aleady "absorbing" huge costs (31% or higher overhead) for healthcare.
"America's Health Insurance Plans, a lobby for insurers, said Tuesday that the government plan proposed by some Senate Democrats could 'dismantle employer-based coverage and significantly increase costs for those who remain in private coverage.'"
First, there will be no need for employer-based coverage under single-payer. This point is actually an advantage of changing.
Second, costs are constantly increasing under the current system. There is no evidence to show that they would do so more significantly under single-payer.
It's hardly surprising that the AMA would oppose a public option. These physicians simply want to continue to enrich themselves at their patients' expense.
q
I'm currently doing work at a doctors house. Place is huge, his kids in high school have brand new mercedes, six cars for four people. But hey, screw public health, as long as these guys get there fat paychecks.
obviously the CULTURE in the USA regarding "doctoring" is:
it Cultivates and encourages doctors - with the AMA at the forefront --
to be EXPERT at ONE THING:
Making MONEY
but BLIND itself to compassion for those in need of their care.
the Sick and needy are for them -- pathways towards the Almighty DOLLAR.
they "sacrificed" during their learning years in school
in order to SACRIFICE PEOPLE at the altar of PROFIT by using their "expertise" to drive people and the economy to BANKRUPTCY
because people - human beings happen to NEED care when health eventually goes awry .
what is that if not VAMPIRISM?.
they are "pretend" caregivers -- these kind of experts -- who use their expertise to SUCK BLOOD out of their own patients.
Amazing - most health-care providers WANT single-pay.
Most doctors I know favor it as well. I guess it is the rich specialists who don't want it.
But I could be wrong !
Dead On. Someone on CD wrote a post yesterday eviscerating "Doctor," not the dr, but 'Doctor' like God....pointing out these greedy sanctimonious creeps were a huge part of the problem by using the AMA to keep the # of dr's extremely low, scarce-high fees.
Nice to see these jerks flayed.
They get into medicine to make money, not help people.
Or else they would go to Africa and teach and care for others.
Like Doctors Without Borders.
Are you implying that DOCTORS are NOT Gods? You must realize that such a sentiment would be considered heresy by the AMA, that union of godly men who have the goal to advance the profit of it's members. I do agree however with your reasoning as to why they go into the medical field.
Of course the AMA will oppose single payer health care, bless their little black hearts. The doctors went on strike in Canada when their system was rolled out in the early '60's. It didn't last long and Canada's doctors are doing just fine although there is no doubt the better specialists could make a fortune beyond their wildest dreams in the current U.S. system.
Under Single Payer, individual doctor's administrative costs would plummet, and the bottomline of their practice would actually increase. So, the AMA's decision to try and uphold the insurance industry is NOT in the best interest of doctors. The AMA is no better than the US Chamber of Commerce, which actively works to destroy small businesses. Interesting how nursing associations and unions are for single payer. Medical services are provided by many more people who far outnumber doctors, and in most instances are far more important in the application of medical care. Note that almost every medical TV program ever produced has focused exclusively on doctors.
Then on top of it all, Single Payer will work to increase the number of patients seeking medical treatment, that will in turn increase the volume of work performed by doctors, which will result in their earning more monies. To be a medical professional and oppose Single Payer is totally illogical and against one's own interest and that of one's community.
the funny thing is:
a great number of Nurses with high education ALREADY are nearly on a par with Doctors in their knowledge of medicine..but just lack the final phase of training which is the "surgery" part.
in reality - because of the system itself - nurses are the ones that actually do MUCH of the diagnoses and even CORRECT the doctors -- for which doctors mainly "sign-off".
and it's the nurses that spend the most time with patients - along with the Nurses' Aides who KNOW for real what the patients go through individually and on a daily basis.
and many nurses are the MAIN bread earners in their families and being women - also are carrying the traditional baggage of raising children at home -- and YET have to be contending with managing their jobs and all that goes with it.
the educational system of PRIVATIZATION ITSELF also leads to the inability of people to BECOME doctors because of the expense -- out of which the AMA uses the rhetoric and justification of how "difficult and expensive" it is that they have to FOREVER be compensated at such huge sums far beyond what their original training required.
the USA should be training medical personell, including doctors at a nationalized way to afford as many as WANT to BECOME SERVANTS of the public good and people in their care.
and FORCE the JUSTIFICATION to "earn as much as possible to compensate ourselves for our expenses in education"
ENTIRELY out of the system -- and ReSTORE medical ETHICS for what it should be:
Study Medicine BECAUSE you want to CURE people -- NOT because you want to be FILTHY RICH compared to your neighbors.
either you are a MONEY MAKER in essence -- and follow that to your heart's content -- OR you serve the good of the people around you that come to you for help when human condition strikes them :
OUR common weaknesses and mortality.
and if that does not satisfy you -despite what WILL BE good compensation ANYWAY --even if LESS than the AMA demands --
if you are not FULFILLED because of that -- you are in the WRONG BUSINESS.
and you shouldn't be USING the illness of people to "make money".
teddy, nice diagnosis and treatment plan.
Particularly more docs, mint them like bottles of wine until we are intoxicated with health-care then start exporting it. A la Cuba & France. And instead of missiles.
"Under Single Payer, individual doctor's administrative costs would plummet, and the bottomline of their practice would actually increase."
I would like to see references for this, please.
Most docs want single payer, but the Demo plan is not single payer.
Even docs who want single payer usually do so for different motivations than their patients, though the conflicts are not mostly unresolvable. They want to be able to practice medicine as they see fit and get paid without hassle. Neither goal is terribly humane or inhumane; both are fairly self-involved.
They probably see that the Demo plan will be a mess. Guess what? They're right.
On the other hand, having a viable public plan makes a better mess for patients: we can more easily choke off the insurance companies.
If the AMA is really opposed to single payer health care which would mean that they were opposed to health care as a human right then they can go rot in their greed infested hell.
EXACTLY
The AMA has always been the conservative wing for the doctors, but their membership has decreased remarkably since their heyday in the 60's. I'm pretty sure their membership may be about 1/3 or less of all doctors, but I'd have to fact check. If you recall in the Michael Moore documentary SiCKO, the head of the AMA in the early sixties (if I am not mistaken and this segment was from the '50's), put out ominous messages about the scare of communism and national health care. Ooh! the bogeyman at our door step!
The doctors who least want a public option are no doubt those in specialties, since they may lose a bit of income. The good thing about single-payer is that it would promote more doctors going into general medicine, where doctors traditionally make less. Those practicing in this field, the family doctors and general practitioners, have been declining in numbers, thus the shortage of them for public needs. The AMA still acts as if it is influential, but fewer and fewer join this association each year.
I remember in the Moore Movie - Sicko -
he was following a British Doctor, probably of pakistani or indian origin, around - in that young man's daily rounds.
he has a Mercedez Benz top line. a FINE large apartment with the whistles and toys - a nice girlfriend..a great social life. goes to his favorite sports and travels where he wants.
asked :
woulnd't you like to work in the USA where they pay even MORE?
he says:
"why would I? here we are paid by the government through the public taxes...in our system -- i am able to see my patients PROPERLY without having to bother about who pays what or how much ...and treat them like real people...AND i am already RICH and successful -- i don't need MORE...i am happy".
Only 30% of the doctors are members of the AMA, and those doctors are usually specialists. They make much more than the generalists, and therefore have more to lose from a more regulated system. For years they were the reason we did not get a non-profit system, but now big pharma and the insurance company lobbies play a larger role.
More generalists belong to the American College of Physicians, and they endorsed single payer in December of 2007.
gkops, where can I find the source of your 30% statistic? Never mind, found some statistics.... tried to 'delete' comment by system wouldn't allow me to do so... N
Physician membership in the AMA has decreased to lower than 19% of practicing physicians, according to the Wikipedia article on the American Medical Association.
If the American people knew that, they wouldn't be much affected by the opinions of this reactionary rump.
The AMA also opposes increasing the supply of physicians through expansion of medical schools. Their day is passed.
Thanks for the information. I suspected doctors are better than that.
Joe
Private health insurance companies are covering 70 percent of the nations insured. What 70 percent is that? The top 20 percent of the nations well to do. What about the 46 million without health coverage? AMA makes me sick.
The AMA is a greedy bunch featherbedding bums
feeding on the back of the people.
I will never be able to understand why the people, young mostly, will volunteer to go all over the world attacking innocent people, but
will not stand up for their right, yes right, to a fair and honest medical system.
The doctors that do not belong to the AMA are like scabs on a union contract, they don't contribute, but still claim the benefits.
These doctors do not advertise lower service cost, they charge the same or higher.
if doctors are in it for the money ....they shouldn't be doctors to begin with.
there are many human beings capable of learning how to cure and help alleviate suffering - that will be happy to receive compensation at a fraction of what these greedy "gods" expect. THAT"s the problem of the culture itself...basing everything on how much money is in it, NOT NECESSARILY in order to live decent lives -- but how to "become a KING or QUEEN" with lots and lots of amenities in life that most people -- namely their own "customers" such as patients - will NEVER be able to afford.
IF "doctoring" becomes their path towards personal aggrandizement and sense of superiority through what they call "just compensation"
they already are COMPROMISED in their ethics and have NO BUSINESS being caregivers.
they want to have MONEY? why go through all the trouble of a VERY difficult profession to learn -- when all they need to do is use their brilliant brains to work in accounting, law, stocks, trading, speculations, wall street gambling and banking etc?.
why BOTHER to study "curing" and caregiving -- while becoming one of the MAIN obstacles to people having what is their NATURAL RIGHT to have as a society, which is caregiving when they need it and when they can't be as strong as they could be?....
why BOTHER to study Caregiving when they really are -- at bottom - just PART of the industry and system that is a PARASITE on a healthy society, through their PROFIT MOTIVES?.
have these American Doctors....or those that subscribe to their system , complaining about how "poorly" they are remunerated...NO SHAME AT ALL?
Some probably VERY unpopular questions to raise:
Why is our health a NATURAL RIGHT? One can argue that one's health is a moral/scoial right, but in no way is it a natural right. When, even, does that moral right expire?
Why do more doctors = more/better care? Are we to educate our doctors like the government has chosen to educate our children with a "no doctor left behind" regiment and produce barely literate (a subjective observation) graduates to then mire the system with even more malpractice suits?
Why do we begrudge doctors their compensation? How many "nightingales" can one expect in a society driven by paychecks? And what quality can one expect from them? Sweeping generalizations and straw-man attacks on an industry that encompasses many GOOD doctors as well as greedy/ineffective doctors do little for the single-payer movement. Single-payer is not designed to castrate doctor's benefits. It is designed to circumvent the ineffective/high-cost to low pay-out of private insurance and its general inability for inclusion of average Americans. The AMA is a dinosaur, lulled to sleep by big pharm and insurance lullabys and needs to be treated as such, but emotionally charged rhetoric does little to advance the single-payer agenda.
Yes, we need a change. Yes, we need it quickly. But blame needs to be placed where blame belongs and change needs to accomodate both the provider and the insured. Single-payer has the backbone and the opportunity, but unless it is administered efectively we risk the chance of adopting one evil for another.
wasn't one of the ancient sayings about Doctors:
"first -- do no harm?"
well -- american doctors that hew to this system of privatized care -- DO MORE HARM before they EVEN meet a single patient because of the system they espouse and allow themselves to be part of...
which is what the CIA economic hitman John Perkins describes as "we are only living the lifestyles we do because it is only PART of a a very , very vicious system of exploitation that dehumanizes and enslaves people everywhere".
and the "doctor system" in the USA IS part of THAT system.
they have NO shame at all.
God bless you for citing John Perkins, the ex-economic hitman - he's done an enormous amount to expose the underbelly of the beast, and I think EVERYONE should read "Confessions of an Economic Hit Man", don't you?
Of COURSE the AMA is against this - my God, it will be socialized medicine, which is the worst horror they can imagine. Never mind the AMA - it, big pharma and the HMOs are responsible for the abysmal state of today's health care, and God forbid they should lose their sinecures. We need a paradigm shift in how health care is handled in this country, and we need it now - too many doctors aren't held accountable; HMO staff are practicing medicine without being licensed to do so, and big pharma is ripping off patients spectacularly. I am a patient advocate and have been one for 30 years - I've never been busier than I am right now, and it's no accident. The latest absurdity was a $350 charge for "wound care" I spotted on a bill - which, when asked about, turned out to be for one - ONE -Band-Aid. Three hundred and fifty dollars for a Band-Aid? What is THAT about? (Rhetorical question - I know, and you know, what that is about.)
Curmudgeon is right that most Doctors want Healthcare Reform. Robert Pear is wrong, however, when he says that "the association (AMA) is probably has more influence than any other group in the healthcare industry." I am a physician who was a member of my state legislature back in 1992, when Bill and Hillary tried healthcare reform. No one wants to look like they are supporting "those rich doctors". The Insurance industry has vastly more power than the physician groups. The Pharmaceutical industry and the Hospital associations all have more influence. Rembursement to hospitals have largely kept up with their costs. There is a continuous back and forth between hospitals and insurance about their cost. Neither the public or private insurers know or care what the costs are for a physicain owned clinic. And over the years the overhead for a clinic has gone up and gone up and reimbursement has not kept up.
The private insurance companies are a pain in the butt to deal with. The only reason the AMA wants to keep them afloat is that they pay physicians more than Medicare or Medicaid. The public plans don't pay for the cost of their patients' care. They cost-shift it to the private insurance companies. For example, at my clinic Medicare only pays 2/3 of what private insurance pays. Medicaid pays 1/2. Our clinic has 70% overhead costs which have to be paid before any doctor takes home a penny. If we only had public plans and they didn't adjust their reimbursement, our clinic and virtually every other doctor's office would be out of business. We are a primary care clinic. The subspecialist do a lot better. The hospital based doctors, such as radiologist have very little overhead. They pay for a billing service and malpractice insurance and every other cost is paid for by the hospital.
Everyone talks about preventative care and primary care, but the fact is they don't pay for it. Primary care takes up 13% of the healthcare dollar. Private insurance companies take around 20%.
what a shock - NOT!
remember folks: these doctors - who are supposedly concerned about their patients - fought FOR caps on medical malpractice awards (blaming trial lawyers instead of themselves and inept medical care), and also fought medicare tooth and nail. take a stand, folks: as YOUR doctor if he/she is an AMA member. if so, go elsewhere. there are plenty of terrific doctors out there who stand for what's right.
Who are the shareholders of the private health insurance companies. Doctors themselves and the AMA ? And yes, public (Americans don't like the word 'socialized') health care does limit options, such as being being conned, ripped off and raped by private corporations. Come on guys, tell your congressmen that you expect them to work for YOU not the CORPORATIONS!
This opposition makes no sense, since the current system requires so much paperwork and adapting to so many different insurers with completely different requirements and deductibles. It seems to me that a single payer solution would eliminate all this double paper work and reduce costs significantly.
To the Mercan Medical Association greed trumps health. No surprises there. What America need is for its doctor members to stage a palace rebellion and stand up to defend their Hippocratic Oath, i.e. health before wealth. Come on docs show us some balls!