A.M.A. Comes Out Against Government Sponsored Healthcare
By Justin Gardner | Related entries in Barack, Democrats, Health Care, Legislation, Money, ObamaLooks like the Dems are going to have to fight the largest physician’s organization in the world.
Yikes.
[...] in comments submitted to the Senate Finance Committee, the American Medical Association said: “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. 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.â€If private insurers are pushed out of the market, the group said, “the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.â€
You mean when compared to exploding costs that the free market has brought about? Considered me unconvinced by that line of reasoning.
And not all doctors who belong to the A.M.A. are on board with this…
The A.M.A., an umbrella group for 180 medical societies, does not speak for all doctors. One group, Physicians for a National Health Program, supports a single-payer system of insurance, in which a single public agency would pay for health services, but most care would still be delivered by private doctors and hospitals. In recent years, some doctors have become so fed up with the administrative hassles of private insurance that they are looking for alternatives.
Actually, I know quite a few folks who say that single payer is really the only way to truly contain costs.
Still, I wonder if the A.M.A. would be in favor of the co-op solution I talked about earlier?
But this “no dice!” statement begs the question…what’s the A.M.A.’s solution? Because costs are exploding anyway? Year after year health care gets less affordable for the majority of Americans AND businesses. So how do the propose we fix this? Because I’m not hearing any solutions out of them as of yet.
Or maybe this is all a strategy to usher in some tort reform. Obama’s going to meet with them soon, and the NY Times points out a bridge he could build…
Mr. Obama’s trip recalls a speech to the A.M.A. in Chicago on June 13, 1993, by Hillary Rodham Clinton. She proposed “a new bargain†in which the White House would limit malpractice lawsuits and free doctors from onerous rules if doctors supported her effort to overhaul the health care system.
Malpractice lawsuits are definitely the bane of physicians’ existence since they drive up insurance to the point where it’s nearly impossible to practice. And this is why we’re seeing physicians cover their ass by giving people every single available test so patient’s can’t sue them. It’s definitely gotten out of control and some type of reform is needed.
More as it develops…
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June 11th, 2009 at 6:30 pm
We shouldn’t oversell this, of course, because the AMA’s opposition to Obamacare is no more dispositive than the ABA’s opposition to tort reform. We owe some degree of deference to the professionals in a field to be affected by legislation, but only to a point. Still, what is particularly useful about the AMA’s decision is that it provides cover to legislators who WANT to say no to Obamacare. I think that most ordinary people instinctively share (even if only in a quite diluted and subconscious sense) the precepts I outlined above, particularly in regard to this issue. If doctors are against Obamacare, that makes the man on the street think twice. Congress – particularly the blue dogs, see my post here – will be subjected to incredible pressure by the leadership, liberal pressure groups, and the administration, to pass Obamacare. The opposition of the AMA is unlikely to convince those legislators who are for it; it may sway those who are on the fence; but its REAL use is that it gives those members who really WANT to say no, but fear the repercussions, something else they can give their constituents with which to resist the pressure.
June 11th, 2009 at 7:08 pm
Actually, I know quite a few folks who say that single payer is really the only way to truly contain costs.
Including me, but not because I think single-payer is necessarily a GOOD thing. See below.
You mean when compared to exploding costs that the free market has brought about?
You mean the same excess cost phenomena seen in ALL advanced industrialized nations, including those with single-payer health care systems?
You do know how single-payer systems “contain costs,” don’t you? They ration health care, often by government fiat. And even that doesn’t work, as sooner or later excess cost growth still means reducing the amount of actual health care delivered through tighter rationing. In anything resembling a democratic system, this in turn results in the voters demanding more health care, which in turn drives up costs again. As the U.K. is painfully aware, with their health care costs consistently climbing over 6+% per yr without any increase in amount of care provided.
Then again, despite what you may hear, the UK does a pretty good job at providing basic health care to everyone. It’s not until you start moving up past the basics that the “triage” rationing factor starts lengthening waits.
But it’s not as if we don’t already ration health care in America. We do, by price and by insurance and by accessibility factors related to same. The argument isn’t IF we are going to ration. The argument is over HOW we are going to ration.
June 11th, 2009 at 8:02 pm
You might have a point on this one. You see, the reason why health care has gotten so expensive is because new technology is constantly being developed, and is constantly outpacing supply. Because nobody cuts their budget by selecting obsolete, less effective health care for the same disorder, the price constantly rises to cover the cost of the newer, more effective treatment.
When the government controls health care, they will use their legal authority to fix prices, which will reduce private investment into new technology and result in a stagnation of new treatments.
We will all pay less because there will be no new cures. Is that a silver lining or what!
Actually, I doubt the reduced investment will actually have an effect on costs, considering the government will be managing the remaining resources anyway, but its worth dreaming about!
June 11th, 2009 at 8:05 pm
ADDENDUM:
Don’t forget that private care will not go away in Obama’s America. It will just eventually become so expensive relative to the government-subsidized health plan that it will be reserved for the hyper-rich. And once the government has all it can handle with Obama-care, the quality will dwindle. If you think there is a two-tiered system now, just wait.
June 11th, 2009 at 8:08 pm
Agreed, Tully.
IMO, those who think that there is some way to avoid rationing don’t understand the problem or are just plain obstinate (and selfish). (IMO) I am particularly sceptical of the AMA and the insurance industry since they profit from the status quo.
June 11th, 2009 at 9:07 pm
Simon: Exactly the kind of insightful post I’ve come to enjoy from you. Thank you. Now, if we can just avoid threads about Sarah …
Jimmy: Hah. Hah hah. Hahahahahahahaha.
June 11th, 2009 at 9:59 pm
My comment above probably makes more sense if taken as an extract from this post – I was writing them both at the same time, and I left a reference in my comment to a paragraph that didn’t survive editing the comment but remained in the post.
June 11th, 2009 at 11:02 pm
I could not care less what doctors have to say. Nurses I’ll listen to with great respect. When my son was born 2 months premature all we saw in the NICU were the nurses. I love nurses.
Tully’s right: there’s rationing now, there will be rationing under a government plan. I trust the government more.
Incidentally, there’s rationing in everything. Only the very rich get to have all they want of everything. Beluga? Very limited supply, very high prices, only the rich can get it. Under a government-run caviar plan the rich would pay even more for caviar, but everyone could have a blini’s worth.
That’s right: I’m combining caviar and prostate exams.
June 12th, 2009 at 12:22 am
this is SUCH a hard topic.
Healthcare coverage is a right, no doubt. But government-run healthcare? Yikes! I’m holding out to see just what this bi-partisan solution really contains…
Anybody else holding their breath?
Nick Stone
Drawnlines Politics Online
June 12th, 2009 at 12:59 am
Agreed with much of what’s being said here. It’s a VERY tough problem to solve, and of course rationing is involved. But as mentioned here and other places, if we can cut back on the amount of unnecessary tests and procedures, that’ll go a long way towards solving the problem. This will also help pave the way to get Medicare and Medicaid reformed.
June 12th, 2009 at 7:05 am
Let’s assume healthcare is a right. Shouldn’t housing/shelter be a right as well? Food? Utilities? The ability to communicate? While I’m not usually a fan of slippery-sloping, I think my list above could be agruable if the precedent that health care is a right. I think that we throw around the word “right” a little too lightly. I think “right” should be reserved for things of the magnitude of say, the Bill of Rights. Those things which we are endowed with by our Creator.
Amendment 1, Revised Subsection B: All Americans have the right to healthcare. Really?
June 12th, 2009 at 8:03 am
Simon: I hope you know I was being genuine, not sarcastic.
Exiled: You make an interesting point but I’m going to have say it should be a right. In this day and age in America health care should not be a privilege. Certainly not while insurance companies are raking in the profit. I worked for a small, regional insurance company that serviced ONLY Maryland. They posted $93m in earnings in the 4th quarter 2006. They’re a little guy.
Even if half that money gets lost in a new bureaucracy, the balance will go a long way to helping people who need it.
June 12th, 2009 at 9:39 am
Exiled, that’s a fair and worthwhile argument, especially if you take the philosophical view that when we are talking about rights, we are talking about morals.
Me, I think about rights in a much more practical and technical sense. As a utilitarian, in other words. So, I don’t think that any of the rights Americans enjoys now were sitting out there in theoretical space throughout the infinite passing of time, just waiting for us to discover them. I think that our “rights” are, in point of fact, whatever we can declare, defend, and enforce.
I see a slippery slope of a chaotic world. We try to make sense of it with a staircase of rights built on that slope. Things we feel we deserve as humans. Free speech, right to bear/defend, and so on and so forth. It’s up to all of us to decide democratically whether or not we’re going to add another step.
If we do add it, it will be because enough people think its worthwhile. And the calculus on “worthwhile” will vary by person. And if we add the step, it will be at great cost, and it will be a drag on our system. And we may well, sooner or later, find that the drag on our system due to rights and entitlements makes the system itself untenable.
BY the way, if any of this makes you wonder whether I am conflating rights with entitlements, I probably am. I’d have to give it some more though before I’d venture to speculate about how different these ideas really are. Off the top of my head, I would say that speaking democratically and legally, they are substantively similar. Hopefully no one will clobber me here, as I am sort of thinking out loud. I am certain that other folks here can come up with big important differences, especially philosophically.
I am working from a perspective of “things we’ve democratically decided we all deserve.
Tully if you are out there, that’s your straight line for the Clint quote. BTW, sorry about your friend George. I can’t even imagine how angry and bitter a pill that is.
June 12th, 2009 at 10:14 am
Justin, I may not have been clear. Excess HC cost growth is not a problem that is difficult to solve. It’s a problem that CAN NOT be solved the way you (and pretty much everyone else) perceive the problem. Required solution parameters in our current society include actually reducing — and continuing to reduce incrementally from baseline on an ongoing basis– the amount of health care we collectively receive (an incrementally-increasing rationing policy that means less and less health care delivered for any given individual over time) and/or halting the development and deployment of new (and higher-priced cost-driving high-demand) HC technology. I suspect it’s “and” rather than “or.”
While I hate to use the popular dichotomy model, it is illustrative. One side says we can halt excess cost growth by using free market principles to reduce the inefficiencies of the current system. The other side says we can we can halt excess cost growth using the power of government and standardization to reduce the inefficiencies of the current system. So on a short-term basis, both are right. Increased efficiencies can conceivably be achieved either way (or some combination thereof) and that will indeed boost system capacity for a time, providing a temporary slowdown/halt in cost growth.
But on a long-term basis, both are wrong. Once the efficiency increases are absorbed by the system, excess cost growth will resume. Because new and more effective tech will still cost more than older tech that has paid off its development costs, and demand for health care will still be inelastic. (Somewhat paradoxically, new tech itself produces some cost reductions over time after it’s passed payoff stage, as it generally is more efficient and effective than old tech and has become cheaper to make, which is why you bother developing it in the first place. But it’s not cheap when it’s NEW. IT doesn’t generally get cheaper until it starts becoming old & standardized tech.)
Once you realize that the excess cost growth problem is inherent regardless of our health care system design, and will continue to manifest as long as HC technology continues to improve and societal income continues to grow unless incrementally-increasing rationing is put in place, THEN you can begin to come to grips with HC reform. We’re a long way from topping out our demand for health care, so the argument becomes how we determine who gets what, what system we use to ration what is available and to pay for and direct new tech development.
Both sides claim they are going to solve the excess cost growth problem with their approaches, both are possibly right short-term but certainly wrong long-term on being able to do that, and both are pretty well aware of that at the upper levels of knowledge, meaning both are selling snake oil as a booster for their preferred approaches.
Note that all of the above applies before we even get into th question of demographically-driven system cost increases. The more effective your health care, the longer people live, the more health care they consume.
June 12th, 2009 at 10:18 am
Hee hee. “Deserve’s got nothin’ to do with it.”
June 12th, 2009 at 12:33 pm
I agree with Tully that when it comes down to it, rationing is the only way to solve a problem of infinite demand and limited supply.
Given that unsustainable cost growth is the big problem, one thing we ought to at least bat about when it comes to rationing is slowing the pace of advancements. Pouring tons of money into R & D sooner or later leads to new advancements. And sadly, the sooner we want the next advance, the more it costs.
For example, we pay high costs for the newest drugs, and part of that is paying higher costs for ALL drugs to fund the R and D on the stuff in the pipeline. How much might we save if the Pharma cos were not constantly flush with cash and pouring dough into the next imagined cash cow?
Please note I am throwing this out as an answer to “if rationing, then what kind?” Slowing the pace of advancements seems morally a bit more palatable than say age- or condition-based rationing of existing treatments with known efficacy. Like denying someone a hip replacement because they are too old or too sick.
One other health claim I ran across, if true, would go some way to clearing the waters of fact from fiction, spin, and rhetoric.
I saw a seemingly well-informed woman on TV a few weeks ago whose name I can’t recall, but she seemed sane. Maybe a congresscritter of some sort. Her interviewer tossed out the old preventative care saw. This woman said that we really all ought to know that while preventative care is a morally desirable thing, the data do not support the oft-floated notion that it’s cost-effective. In general, it costs more money to give everyone periodic screenings for disease x than it costs to treat disease x after it occurs.
Of course, disease x could kill you. And of course, for many diseases like cancer, early detection is key for efficacious treatment.
But that simply reinforces the point that preventative care, while morally desirable, is not a cost-controller. And note that it is invariably healthcare professionals who are pushing preventative care, thereby supporting the growth of their industry.
I am not opposed to prventative care. I just think we ought ot get it straight that if you are talking about controlling cost, then preventative care is actually and regrettably part of the problem, not part of the solution.
June 12th, 2009 at 12:41 pm
I see now that my previous post relates to a point JtD brought up. Jim mi, I think that is reasonable to wonder that maybe less, if we need to control cost growths, slowing the pace of future advancements could be a morally more desirable way to ration than other approaches.
Of course, if I contract a currently incurable disease, I may change my mind. :-)
June 12th, 2009 at 12:56 pm
So, take the resources for stem-cell research (for example) on a Parkinson’s treatment/cure and use it to pay for basic medical services for a chunk of the population. Interesting. Not sure if the entrepreneurial/pioneering mindset of the archetypical “American” would go for that, though. Culturally we’re about innovating. Kinda like telling the Shiites that they shouldn’t be so darned devout. I mean, we’re the culture of the Slap-Chop, for Pete’s sake.
But, the core of your point seems to be that if we want to expand access to medical services (won’t debate that assumption here), there will have to be sacrifice made somewhere in the overall “system.”
June 13th, 2009 at 3:45 pm
[...] with a public plan is that they would drop expensive private policies in favor of the public plan; AMA lines up on the wrong side, as usual; how mandatory health care would “work”; Pelosi [...]
June 18th, 2009 at 9:01 am
There is a very simple solution to healthcare crises: we need to strip AMA from power to regulate admittance to medical schools, which artificially creates the shortage of doctors and boosts their salaries by preventing competition between them. If demand for medical services is balanced by supply of doctors, then, with the help of competition, the price would automatically go down to affordable level and hopefully nobody would need a medical insurance. This is the only free market solution for this problem. What Obama is proposing would replace one monopoly by another – AMA, which has significant, but still limited lobbying power, by Government, which has almost unlimited power. This would be the worst form of monopoly: patients wouldn’t have a freedom to choose and doctors wouldn’t have a freedom to set the price.