Wednesday, October 21, 2009

On the AMA and Prostitutes

Wow, some choice words on the Senate floor from Tennessee Republican Senator Bob Corker yesterday on the Hill:
We all know that the selling of one’s body is one of the oldest businesses that has existed in the history of the world. And so the AMA now is engaged in basically selling the support of its body by throwing future generations under the bus by in essence urging that we as Congress pass this week a quarter of a trillion spending bill, unpaid for. And if we would do that we might get their support in health care reform.
Heh. One wonders if he's been reading this blog.

In all seriousness, the mashinations going on the Hill often leave me perplexed. Fortunately, all one has to do in such a situation is turn to a fellow cardiac electrophysiologist to help explain things, and no one does it better than Dr. Rich over at the Covert Rationing blog:
Furthermore, the Democrats have to find a way to pay for their healthcare reforms without alienating some of their key constituencies. Reforming healthcare will be so supremely expensive that it will be utterly impossible to actually pay for it only by taking money from the rich. The Democrat reform plans that we know a little about reveal this problem. HR 3200, for instance, according to the CBO, explodes the federal deficit. And the Baucus plan introduces fees, penalties and surcharges that threaten to affect many if not most middle-class Americans (including, worst of all, members of labor unions with very nice health plans). To pass a bill, the Democratic leadership will have to sell the fiction that the whole thing can be paid for without causing any of their key constituencies any significant fiscal pain.

Perhaps the biggest problem of all is that with any healthcare reform “victory,” Democrats will have to take control of covert healthcare rationing. Covert rationing will be much more difficult for a government-run system than it has been for insurance companies. A government healthcare system will not have the opportunity to incorporate the most effective rationing techniques that have been available to the insurance industry - cherrypicking patients, for instance, or canceling the policies of people who get sick. Nor will the government be able to get away with summarily denying patients needed medical services - a standard tactic of HMOs. This is especially true now that chief Republican intellectuals have called everyone’s attention to the possibility of death panels. The unwashed masses, having been duly alerted to the government’s intentions of withholding life-saving healthcare, will now be on the lookout for “unreasonable” denials of care. Any move by the government to refuse to pay for a particular medical service will have to be supported by extremely convincing clinical data (which itself will be very expensive to collect), and even then Americans may not quietly accept such denials. The “death panel watchdogs” will be alert for every move the government makes, and will be quick to howl an alarm.

So even though the Democrats are in complete control of the process - the only people they have to convince to vote for reform being other Democrats - and even though they have the insurance industry in their pocket (unless they continue to alienate them by reneging on deals), assembling a reform plan that Congress will pass remains a huge challenge.
In summary then, if the AMA is the fiscally irresponsible prostitute, then Congress is their pimp.



Keith said...

Horse trading has been going on in Congress from the begining of its existence, so I fail to see why the Republicans are amazed by this tit for tat. If you as an individual doctor were approached by the goverment with this deal (support our health care reform bill and we will not cut your pay by 25%), would you turn down that offer? I think not!

In truth, there is no way that a 25% cut accross the board would be allowed, since it would make practice unviable for many physicians, primary care in particular, where it is nearly unviable already. But what the AMA is getting is the end of the SGR, which has created perverse economics for physician pay long enough. Those who benefit under RBRVS are those doctors who develop the most expensive services, and the result is to devalue other physician services that may have greater value. So if you can treat say low back pain with either conservative treatment/rest/analgesics/etc or do an expensive surgical procedure to get the same result, which do you think gets the monetary reward? This only fuels health care inflation with no commensurate increase in overall health if your system is designed to encourage the most expensive forms of treatment, even if they are of equal efficacy.

The AMAs motivation may be self interest (as it probably should be and always has been), but for once they are actually getting it right.

American Medical Association said...

The Senate's inability to preserve access to care for seniors, baby boomers and military families is deeply disappointing. Nearly every physician group, including AMA, supported S.1776, along with AARP and the Military Officers Association of America.

The latest round of finger-pointing and gross accusations highlight the deeply political atmosphere in the U.S. Senate where common ground - even on an issue that has wide bipartisan support - has become elusive. Congress created the "SGR" problem, and its up to Congress to solve it once and for all this year. Permanent repeal of the Medicare physician payment formula is essential to comprehensive health system reform, and AMA will stay active in the legislative process to get reform for patients and physicians.