What Do Doctors Prescribe on Health Care?

By Gorman Gorman

Jun 15, 2009 9:19am

"We've made it clear that we think there should be a public plan," Vice President Biden said yesterday.

"But a public plan is on a continuum.  For example, there was a, there, there was a, a big headline saying the AMA says they won't support a public plan and no one will support a public plan.  Well, the truth of the matter is the AMA said certain kinds of public plans they might support.  So the question is, what is the public plan?  Is the public plan just, just Medicare?  Is that the public plan?  Do you add everybody onto Medicare who is going to need help?  Or is a public plan something further down the continuum?"

The vice president was referring to a June 11 statement from outgoing AMA President Nancy Nielsen saying, “Make no mistake: Health reform that covers the uninsured is AMA's top priority this year. Every American deserves affordable, high-quality health care coverage. Today's New York Times story creates a false impression about the AMA's position on a public plan option in health care reform legislation. The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, but the AMA is willing to consider other variations of a public plan that are currently under discussion in Congress. This includes a federally chartered co-op health plan or a level playing field option for all plans. The AMA is working to achieve meaningful health reform this year and is ready to stand behind legislation that includes coverage options that work for patients and physicians.”

What the AMA said to the Senate Finance Committee in a document obtained by ABC News was that 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.”

The AMA suggested that because such a plan would likely receive “special advantages and government subsidies that would not be available to private insurers” in turn “private insurers would be pushed out of the market entirely. 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.”

The physicians’ organization also suggested that if the government were to use its authority to artificially hold prices below market rates for this public plan, as it has done with Medicare and Medicaid, “the country could see an increase in cost shifting to private carriers and providers” which would lead “to higher costs for consumers in private plans.”

The AMA said it agrees with the Senate Finance Committee that, "were a public health insurance option to be pursued, several design details require careful consideration." The AMA does not support the establishment of a “Medicare-Like Plan” since "in its current form is unsustainable for patients, physicians, and the country." The AMA opposes "any plan design that mandates physician participation" since "many physicians and providers may not have the capability to accept the influx of new patients that could result from such a mandate."

- jpt

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