Who Will Be at the Table? PhRMA and the AMA Join Forces with Insurers

During the campaign, Barack Obama promised his cheering crowds
that, when he rolled up his sleeves to work on health care, he would
"have insurance company representatives and drug company
representatives at the table. They just won't be able to buy every
chair." Now is a good time to look at just what kind of seats special
interest groups are having at Obama's table and what they're doing to
bring the public around to their ways of thinking. This is the ninth of
an occasional series of posts that will analyze their activities and
how the media are covering them. The entire series is archived here.

Advocates fixated on a public option health plan as a step toward
national health insurance have spent months casting the insurance
companies as bad guys-fat cats who make too much profit, choke the
current health care system, and shower legislators with big bucks for
their campaign chests. Most stories emphasize that insurers are
fighting such a plan because it could put them out of business by
offering lower premiums, controlling costs, and being more efficient.
For awhile, I was beginning to think that other stakeholders-who oppose
a public plan just as fiercely-were getting a free pass.

There has been no media scorn for the doctors or the hospitals or
the drug companies that are considered good guys because they make sick
people well. The press has not picked up on their opposition, and
lobbyists have begun calling in their Capitol Hill chits. Friday, The American Prospect co-editor Robert Kuttner gave his thoughts
about a public plan on the magazine's blog, unsurprisingly referring to
the "immense power of the private insurance industry." No mention that
the AMA, the drug companies, and hospitals don't want a public plan
either. Their reason: A public plan might pay them lower prices for
their services, or set other regulations they don't like, or force
private insurers to pay them less, too. That's why some compromisers
like New York Sen. Charles Schumer have proposed a plan
that would pay these groups higher rates than Medicare, and would
follow the same rules, such as maintaining reserves against future
claims.

Former Clinton administration labor secretary Robert Reich, now a professor at the University of California-Berkeley, reveals
that drug makers and insurers have teamed up to kill the public option,
and that many moderate Dems and Republicans seem to be embracing softer
versions of a public plan. Count the AMA on the insurer-drug team as
well.

Most journalists, let alone the public, haven't read the lengthy comments
the AMA submitted to the Senate Finance Committee, laying out what the
AMA really wants. But Kuttner, Reich, and other influential bloggers
and MSM reporters should take a good look, and offer a more informed
discussion of the AMA's actions.

The group, which represents the hard-liners of organized medicine,
has been as instrumental as insurers in blocking serious health reform
over the decades-not only with their campaign contributions (the AMA
ranks second only to the U.S. Chamber of Commerce over the last ten
years in the amount it has spent to influence Congress) but also with
other forms of public pressure. Like insurers, they started out by
being oh-so-agreeable. Early this year, the AMA even tried to position itself
as the "Voice for the Uninsured." But look what it stands for now. Some
of its proposals look like they were cloned from those of AHIP, the
insurers' trade group.

According to the AMA, the magic of the market will bring insurance
to all. To that end, it supports letting markets create the most
attractive combinations of plan benefits and premiums. It wants to tax
some insurance benefits provided by employers and shift some of the
newly created tax revenue to tax credits or vouchers for the uninsured,
and it supports the individual mandate, which would require people to
buy insurance in the private market if they coud afford it. The
individual mandate is the sine qua non of the insurers' reform agenda.

Along the way, the AMA wants to rid the market of state-mandated
benefits, also high on the insurers' wish list. "Appropriate
regulations and fewer benefit mandates would permit market
experimentation to find the most attractive combinations of plan
benefits," the docs say. No self-respecting insurance carrier would
disagree. It opposes letting people between age fifty-five and
sixty-four buy into Medicare, even temporarily. The AMA has a proposal
for the youngsters, too. It suggests that the government offer tax
credits or vouchers to parents of kids enrolled in SCHIP, the State
Children's Health Insurance Program, to make it easier to buy health
coverage in the private market. In other words, it wants to begin
eroding government coverage for poor kids.

The AMA doesn't care for a public insurance option, either. Here's what the doctors say:

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. A crowd-out of private
insurers and the corresponding surge in public plan participation would
likely lead to an explosion of costs that would need to be absorbed by
taxpayers.

There you have it-is this the same old AMA opposing anything that
even remotely looks, smells, or quacks like an entree to national
health insurance? Is it 1948 all over again? Health care journalists
should make it their business to find out.