What Do Doctors Prescribe on Health Care?
Email"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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I wish I could remember where I read it, but one article wrote about the AMA or doctors saying that one of the greatest reason that health care costs are high is because of malpractice insurance costs and rear of malpractice suits. Thus they may order unnecessary tests/etc. to cover their bases.
If this is true, then the solution to high costs is in addressing the litigious nature of medical costs.
Posted by: SjB | June 15, 2009, 9:48 am 9:48 am
SjB:”If this is true, then the solution to high costs is in addressing the litigious nature of medical costs.”
Obama has stated that this is indeed a major issue, when he proposed a cap on pain and suffering awards:
“One of the major cost drivers in the delivery of health care are these junk and frivolous lawsuits.” He said rising malpractice insurance premiums and needless medical procedures ordered up out of fear of lawsuits cost federal taxpayers “at least” $28 billion a year in added costs to government medical programs.
BUT – his claim was based on a single research paper out of Stanford. When the GAO and CBO looked into it and tried to verify and expand the research methodology, they found:
“In short, the evidence available to date does not make a strong case that restricting malpractice liability would have a significant effect, either positive or negative, on economic efficiency,”the CBO said.
Unnecessary procedures are indeed a problem, but the actual data suggests the desire to pad ones pay check is as likely as fear of malpractice.
Posted by: jhw539 | June 15, 2009, 10:08 am 10:08 am
The AMA has become a paper tiger whose roar is much more fearful than its bite. Less than 19% of physicians belong to the AMA. Their influence has been declining in part due to their stubborn resistance to real change in our profit-driven, dysfuctional healthcare system. Many of the non-AMA doctors support a greater government role in healthcare, especially a single payer program. Like many symbols, whose legitimacy resides in perceptions – the AMA’s influence comes primarily from fear. Their disproportionate power goes against last November’s election mandate. Congress and the President need to heed the will of the VOTERS.
Posted by: Mark from atlanta | June 15, 2009, 10:27 am 10:27 am
yes jhw this is correct. In medical school we are taught to practice defensive medicine. That is, even when we “know” the particular illness, we will order more tests that way if we are ever questioned, it is easier to say, look, i ordered all these tests versus, my training told me this….that drives up costs alot.
Posted by: medical student | June 15, 2009, 10:55 am 10:55 am
If everything could stay as it is, I would be thrilled to keep my fine retirement health plan for life. But the current system, with it’s trends, is unsustainable.
The article tells us “the AMA opposes…..the AMA is willing to consider other variations…..the AMA does not support…..The AMA said it agrees..several design details require careful consideration”
What variations, design details, etc?
The AMA claims, “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.”
But it doesn’t tell us WHAT works!
Since the AMA seems to have it figured out so precisely what’s going to happen to any current potential government plan, why aren’t their experts generating alternative, less-costly solutions?
Posted by: The_Mick | June 15, 2009, 11:03 am 11:03 am
If we study other industrialized countries’ successful public health care systems (we’re the only one without one) we might learn something. Just because we are the US does not mean we know everything. Actually, because we cannot come up with a functional health care system indicates we are not very smart. “First thing, get rid of all the lawyers” — William Shakespeare
Posted by: fuzzy | June 15, 2009, 11:51 am 11:51 am
The only possible solution or helpful government role that I can see is to limit the premiums that insurance companies can charge for whatever groups, like an inverse graduated income tax. The competition against that would be out-of pocket payment for services. There is no other limit that the government can place. The reasons are 1)Healthcare is too complicated to manage centrally with any effectiveness whatsoever 2)The government cannot force a tax to pay for healthcare without mass exodus from citizenship, besides the inefficiencies of central management, especially in healthcare 3)The government cannot limit what people pay for services out-of-pocket without unleashing an underground economy for shoddy medical services, apart from the impossibilty of telling Americans that we can’t buy our own health out-of-pocket, if we want to.
Posted by: MarkLeavenworth | June 15, 2009, 11:52 am 11:52 am
To limit the resources used on healthcare is to limit the doctors, the nurses, the technicians, the builders, the researchers, the accountants, the policy supervisors, the government overseers, the patients, in general, to limit the time spent trying to take care of people and their ills.
If this is a good idea, then there is only one place a limit can be placed by the government. It must be placed at the insurance premium. This limit cannot be subsidized at the premium side, but at the service side, because individuals must be able to offer an out-of-pocket payment that can compete with the premium. It can be limited at the premium side, though, based on what people can afford. The industry then must work within these limits at all the various levels to make the best use of the resources, just as they do now, only now there are no limits.
Posted by: MarkLeavenworth | June 15, 2009, 12:03 pm 12:03 pm
1. Get it out of the employment domain.
2. Tax Credit.
3. Free market.
Posted by: Gary | June 15, 2009, 12:59 pm 12:59 pm
I would be surprised if there is not a financial crisis in the healthcare industry similar to the banking crisis, built on leveraged accounts for which no cash-flows will follow. Purchasing these accounts from Insurance companies is one way to subsidize the industry, which should be done a competetive, reverse auction kind of process or credit term facility. If the crisis is too great, then I’m afraid we all have to brace for another bail-out before systematic limits could take effect, if they are imposed.
Posted by: MarkLeavenworth | June 15, 2009, 1:01 pm 1:01 pm
Nice point, Gary. If it was illegal for employers to provide health insurance, prices would adjust to the resources individuals have available, instead of to the leveraging ability of trans-national shadow banking systems.
Posted by: MarkLeavenworth | June 15, 2009, 1:05 pm 1:05 pm
Perhaps this is of interest?
In Wisconsin, Barack Obama supposedly fields “spontaneous” health-care questions from . . . a former Democratic Party candidate for Congress:
This questioner can be seen in a CNN video covering the Green Bay event. The woman is identified as “Paulette Guerin” and labeled as an “attendee” of the meeting on the CNN segment. In fact CNN got the spelling of the woman’s last name wrong, it’s not Guerin, but Garin. . . .
Garin was a recent Democrat candidate for Wisconsin’s 1st Congressional District. Not only that but Garin is a proponent of a single-payer plan, as Obama was when he was a Senator from Illinois. In fact, Garin says right on her webpage that Obama is a proponent of the single payer plan and she urges fellow Wisconsinites to flood Congress with calls to implement the single payer system . .
Posted by: Ordinary Sadie | June 15, 2009, 1:20 pm 1:20 pm
Anyone compared Obama’s proposed plans to how well Massachusett’s Health Care is working?
When Massachusetts passed its pioneering health care reforms in 2006, critics warned that they would result in a slow but steady spiral downward toward a government-run health care system. Three years later, those predictions appear to be coming true:
Although the state has reduced the number of residents without health insurance, 200,000 people remain uninsured. Moreover, the increase in the number of insured is primarily due to the state’s generous subsidies, not the celebrated individual mandate.
Health care costs continue to rise much faster than the national average. Since 2006, total state health care spending has increased by 28 percent. Insurance premiums have increased by 8–10 percent per year, nearly double the national average.
Michael Tanner is a senior fellow with the Cato Institute and coauthor of Healthy Competition: What’s Holding Back Health Care and How to Free It (2007).
More by Michael D. Tanner
New regulations and bureaucracy are limiting consumer choice and adding to health care costs.
Program costs have skyrocketed.
Despite tax increases, the program faces huge deficits. The state is considering caps on insurance premiums, cuts in reimbursements to providers, and even the possibility of a “global budget” on health care spending—with its attendant rationing.
A shortage of providers, combined with increased demand, is increasing waiting times to see a physicia
Posted by: Ordinary Sadie | June 15, 2009, 2:10 pm 2:10 pm
Obama specifically said in his speech today that he was not proposing a cap on awards.
Posted by: jennifert7 | June 15, 2009, 2:11 pm 2:11 pm
Typical Obama:
He will curb malpractice cost by not capping fees and instructing doctors to not practice defensive medicine.
That is as brilliant as fixing the deficit by spending a trillion bucks.
The man is becoming a laughing stock.
Posted by: Plumber | June 15, 2009, 2:16 pm 2:16 pm
The MA health care plan was destroyed by Deval Patrick’s insistence on rewarding his buddies with such things as mandatory podiatry coverage.
Of course President Obama would never ever reward his buddies …
Posted by: Plumber | June 15, 2009, 2:25 pm 2:25 pm
Another thing I would like to ask is – has anyone checked out who all of the uninsured people are and why Obama wants to put everyone under Obama Care? Medicare doesn’t work, why should an expanded version work any better?
See this interesting tidbit:
On Sunday, George Will during the panel discussion on ABC’s “This Week,” said:
WILL: Donna [Brazile], you talk about the 46, 47 million uninsured. Fourteen million of them are already eligible for other government programs and haven’t signed up. Ten million are in households with household incomes of $75,000 a year and could afford it if they wanted to.
Furthermore, an enormous number in that 47 million are not American citizens. Sixty percent of the uninsured in San Francisco are not citizens.
Posted by: Ordinary Sadie | June 15, 2009, 2:48 pm 2:48 pm
“On Sunday, George Will during the panel discussion on ABC’s “This Week,” said:”
George Will is quoting Betsy McCaughey who is a paid shill for the health insurance companies.
She had an article during the election is which she made up various parts of Obama’s health plan.
Like any right wing shill, her facts should be checked before any posting.
Posted by: Ryan C | June 15, 2009, 3:41 pm 3:41 pm
The poor doctors got whiplash during Obama’s speech. He implied he might consider tort reform and then he said that was not part of the plan.
At first the good doctors applauded him and then silence when he pulled tort reform off the table. It was a wicked bait and switch. It PO’d quite a few in the audience. Hope and then change…
Posted by: WhereWasThePress? | June 15, 2009, 3:44 pm 3:44 pm
The Doctors would like the POTUS to make a similar visit to the Trial Lawyers’ Association.
Posted by: DontGet818OnMeNow | June 15, 2009, 3:59 pm 3:59 pm
1/5 of all the money in the United States is spent on healthcare, so I don’t understand why they have the nerve to oppose reform when even if we only spent 1/10 on healthcare they would still be making good money.
Posted by: Nathan | June 15, 2009, 4:01 pm 4:01 pm
Nathan.. your answer might be best handled by the sales rep. at the Mercedes dealership.
Posted by: DontGet818OnMeNow | June 15, 2009, 4:28 pm 4:28 pm
Ryan C- ‘shill’…isn’t that a Brittish term?…
Posted by: MarkLeavenworth | June 15, 2009, 5:09 pm 5:09 pm
An ex-Scottish Highlander took over one of our local hospital computer systems starting four years ago. I didn’t think anything of it…maybe I should have/
Posted by: MarkLeavenworth | June 15, 2009, 5:11 pm 5:11 pm
‘good money’…I don’t know if you realize how many doctors are having trouble paying for their medical school loans.
Posted by: MarkLeavenworth | June 15, 2009, 5:19 pm 5:19 pm
Obama’s plan is Government run health care, and he is willing to Bait and Switch or do anything to achieve this agenda. I hope the Doctor’s did not fall for this LIAR’S TELEPROMPTER SCRIPTED BS!!
I watched a video today of Obama speaking before an audience in 2002 stating his desire for a single payer plan. No wonder he got boo’d today!
Posted by: Sunnyr | June 15, 2009, 11:32 pm 11:32 pm