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Columbia Journalism Review

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

Trudy Lieberman

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 entrée to national health insurance? Is it 1948 all over again? Health care journalists should make it their business to find out.

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Trudy Lieberman directs the health and medical reporting program in the graduate school of journalism at City University of New York, and is a longtime contributing editor to the Columbia Journalism Review. A complete archive of her Campaign Desk articles can be found here.

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