On the position of organized medicine: the AMA and how it represents physicians ……
The recent slaps in the face of physicians (remember the Obama comments about ‘taking out tonsils’ or ‘amputations’ for profit) with similar sentiments by henchmen Reid and Pelosi) are but a few of countless examples of the complete disdain for physician voices in the ongoing “health care reform” debate. While conduct and comments of this sort should have awakened the medical community long ago, I am skeptical that my colleagues understand it.
The vapid, conciliatory, and utterly complete capitulation of the AMA to the current climate of so-called “reform” is clear evidence that physicians need strong new leadership. Falsely purported to represent the majority of US physicians by not only the organization itself but also the administration, the AMA has shown that its revenue–and not principles or tenets of effective organized medicine–is the business model of the AMA.
It pays to clarify what the AMA really is, what it represents, and how “in touch” the organization actually is. Take a recent statement by AMA President James Rohack “Our agenda, as the AMA fighting for health system reform, is to make a broken health care system for millions of Americans more secure and stable.” Well, I wonder where Dr. Rohack would choose to have his CABG, cancer treatment, or hip replacement? Don’t think for a minute that it would be anywhere but right here — in our “broken” health care system! But let’s look closer at the AMA and fellows like Dr. Rohack.
In addition to the enormous membership dues it receives, those which yield few or no useful benefits, the dirty little secret is that the AMA’s “deal making” with big government is not new. It began as far back as the 1980s. At that time, the AMA was granted an ‘exclusive contract’ by the government (yes, a monopoly crafted by physicians!) and given sole ownership of the only billing codes allowed to be used by government programs. In return, the AMA has (for nearly 30 years!) provided maintenance and updating of the data and codes at no cost to the government. Now, the original deal related only to Medicare and other government insurance programs. But since then, Congress expanded the regulation to require the codes to be used in electronic billing transactions with private insurers (socialism is the term, I believe), and that regulation exists to date!
As the owner and publisher of the codes, the AMA is represented in 11 of 17 seats on an advisory panel that creates codes for new procedures and sets values for each code. Insurers, a government official, and other providers fill the remaining seats on the board, which is lobbied heavily by those in medical specialties who seek the highest reimbursements for new treatments. Karen Serkes, Policy Director for an AMA competitor organization, the American Association of Physicians and Surgeons (AAPS), likens the current code system to IRS tax forms. She questions why doctors and practitioners should have to lobby a trade group for regulatory favors, then have to purchase required materials from that same group. “The government requires us to use IRS forms,” Serkes said. “Imagine the outcry if people were charged for these pieces of paper (and the directions for filling out the forms) that the government requires you to use.”
So how the AMA can represent the interests of doctors and medicine while it relies on massive revenues that come from a government-sanctioned monopoly is easily answered—it cannot. The AMA knowingly gouges hundreds of thousands of physicians, other providers, and healthcare organizations by the sale of its exorbitantly priced coding books, software, and software licenses, including the AMA sponsored courses to use them. The estimates of “Codinggate” revenues range from 50 to 100 million dollars annually (although AMA leadership is tight lipped about it); over the course of the last 25 years, it is in the billions. And oh, by the way, AMA members quickly find out that this “cash cow” is not a benefit of their membership!
Most physicians are altruistic, humanistic, and selfless, and so many find the political process and its machinations quite distasteful. When they finished medical school and residency, they hardly envisioned having to write Congress, petition their elected representatives, attend “law days” or become active in the political process. But this is the new reality for physicians, some who, I believe, still don’t “get it”.
Particularly in the eye of politicians, physicians should just keep quiet and take care of patients. Never mind politics, Doctors! But of course, these same politicians who are now reengineering (read destroying) the best health care system in the world will enjoy “Cadillac” health care plans for life–the bennies of serving just one term in the House or Senate! These same folks have no problem telling Americans to “accept” what they are going to be ‘given’– rationing of substandard care in endless waiting lines; while also advising physicians to just “accept” what they are ‘given’—a chaotic, incompetent system providing substandard care. But the worst part of it all is that physicians will be enduring all this while receiving substandard reimbursement and an ever expanding role of government intrusion in the delivery of that (substandard) care.
Many physicians are labor neophytes, uninformed about organization of the type that gets its voice heard around the country and in Washington. And while the data are not readily available, most physicians do not come from families with a blue collar, union background. And for those that do, organized labor and unions are not what most physicians would find palatable or “politically correct” activities.
A slaptrap conglomeration of fragmented specialty societies that attempt to amalgamate into a viable entity in times of crisis is not that “voice”. In its attempts to cajole the current administration, the AMA has failed miserably in addressing essential issues–tort reform, physician reimbursement, working conditions, limiting government interference into private business, and protecting the doctor-patient relationship. That relationship should be and is just as sacrosanct as the lawyer-client confidentiality we so often hear about (but our elected officials wish to abrogate)!
So physicians need true organization to bring a real “voice” to the negotiating table in the political arena. But since elected representatives are in large part law professional, it is easy to see how the doctor-patient matter is ignored.
Now how true organization of medicine and physicians is formulated into law is a constitutional matter of the first order. Because dealing with issues like health care reform on an altruistic, humanistic, and “common sense” basis has NOT worked – and is even laughed at by the current “change at all costs” administration which, because we have zero power, is outright ignoring the voices of US physicians.
Even worse, much of the “reform” sentiment of the exceedingly few MDs who back the current disastrous changes (widely reported as general AMA “support” for Obamacare) is generated in the ivory towers of large teaching centers (read ‘academia’) where staff physicians can wax philosophical about how things should be down in the trenches (i.e. the real world). Sadly, it is a world these physicians never see as they are cloistered in their cushy tenured faculty positions with resident slaves doing the “heavy lifting”—all this under corporate programs which guarantee health care (and a job) for life.
To have any “voice” or a “seat at the table” (as the AMA and ACS, for example, like to call it) in the current discussion of health care reform, you must have organized power. It pays to remember that only weeks ago, “Cadillac” health plans held by labor union members magically were exempted from taxes until 2018, while their nonunion counterparts with such plans will not be exempt. So as unsavory as unions (SEIU, Teamsters, IBEW, UAW, etc) might seem, it is this very power that translates into action on Capitol hill and across the country. But physicians have none. And by current law, can have none!
Now, how union power is achieved is a major legislative challenge confronting medicine. Right now, the cards (poorly written laws prohibiting organization by professionals) remain stacked against such organization in the professions. And right now, the AMA having sold out its physicians, has let the government control horse out of the barn.
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Wed, Apr 14, 2010
Health Care, Homepage Featured Story, RLCNEF Blog