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AMA Sells Out



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Earlier in the week, the American Medical Association (AMA), the nation’s largest physician organization, declared its backing for the most recent version of Obamacare.

Doctors are notoriously bad businessman and, judging from the AMA’s haste to support pretty much any bill Congress proposes, it seems that negotiating is not the strong suit of physicians, either. During the prolonged health-care debate, the AMA sought two sensible reforms: an abolishment of the SGR and tort reform.

The Sustainable Growth Rate (SGR) is a formula utilized by Medicare to determine Medicare physician reimbursement rates for the following year. Every year since 2002, the SGR has called for a reduction in doctor-reimbursement rates, and in all but one of those years Congress has intervened to preclude the cuts. The AMA demanded this punitive reimbursement system be reformed — a reasonable request, especially considering it is overturned annually, anyway. In addition, the AMA lobbied for tort reform — a policy strongly supported by the health-care community that has all too often witnessed firsthand how an elite cabal of lawyers exploit the system, taking advantage of both doctors and patients alike. In the end, neither was included in the bill; regardless, the organization could not wait to announce its support.

As a physician, the AMA’s support is especially difficult to comprehend. It really makes no sense at all. Rather than attacking the numerous perverse incentives, regulations, and red tape that hinder the practice of medicine and result in escalating costs, the bills actually expand their scope.

During the current debate, insurance companies and their executives (despite offering a product with an over 80 percent approval rating amongst their customers) have been vilified as public enemy number one. The Senate bill establishes the seeds to severely limit, if not eliminate, private health insurance. At the very least, it converts a private industry into essentially a public utility. When costs continue to rise and fantasy savings from preventive medicine, electronic health records, and WFA fail to materialize, who exactly will be left to blame? One thing is for certain: When legislation proves destructive to health-care quality while raising costs, Ms. Pelosi and Mr. Reid surely will not blame themselves. Doctors will pose a tempting target to carry that mantle. Mr. Obama’s remarks earlier in the summer could very well be a harbinger of things to come:

Right now, doctors, a lot of times, are forced to make decisions based on the fee payment schedule that’s out there. So if they’re looking and — and you come in and you’ve got a bad sore throat, or your child has a bad sore throat, or has repeated sore throats, the doctor may look at the reimbursement system and say to himself, “You know what? I make a lot more money if I take this kid’s tonsils out.”

He made similar comments regarding physicians being tempted to amputate an extremity for a bigger pay day as opposed to more conservative treatment.

It is no surprise that multiple national doctor organizations oppose Obamacare. A recent IBD/TIPP poll discovered that 65 percent of doctors do not support the so-called reform efforts. By supporting this bill, the AMA, which represents only 18 percent of practicing physicians, has done a great disservice to its dwindling membership as well as all doctors, patients, and the world’s premier health-care system. It’s hard to believe the AMA’s leadership could be so short-sighted — and for apparently nothing other than the opportunity to mingle with the in crowd.

The AMA’s board members might want to consider enrolling in Negotiating 101 this upcoming semester. Rumor has it that Nebraska senator Ben Nelson and Louisiana senator Mary Landrieu will be guest lecturing.

– Jason Fodeman, M.D., is an internal medicine resident at the University of Connecticut. A former health-policy fellow at the Heritage Foundation, he is the author of How to Destroy a Village: What the Clintons Taught a Seventeen Year Old.



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