At the annual meeting of the AMA House of Delegates in Chicago, President Obama made an appearance to court physician support for his ideas for a comprehensive, government-directed “overhaul” of American medicine. Reportedly, he got a standing ovation from polite delegates, though there was a smattering of “boos” when he expressed opposition to limits on malpractice awards.
“Now, just hold on to your horses here, guys,” he told doctors when they applauded him for sympathizing with their worries about lawsuits. “I want to be honest with you. I’m not advocating caps on malpractice awards—which I personally believe can be unfair to people who’ve been wrongfully harmed.”
Obama called opponents of his plan “naysayers,” “fear-mongers,” and “peddlers of ‘Trojan horse’ falsehoods.” One such opponent is Representative Tom Price, M.D., of Georgia, an orthopedic surgeon, who calls the Obama proposal a “government takeover” that will set up a rationing board.
Obama stated publicly, for the first time, that his proposed “reshaping” would cost “about $1 trillion over 10 years.” That would include covering almost 50 million Americans who don’t have insurance. But not to worry: he ticked off $950 billion in hypothetical savings. These include cutting payments to hospitals for care of the uninsured, cuts in overpayments to Medicare Advantage plans, “adjusting” Medicare payments to reflect new advances, introducing generic biologic drugs, and reducing preventable hospital readmissions. This doesn’t count savings from computerization, prevention, and other things that the Congressional Budget Office can’t score.
There would also be revenue increases, as by “modestly limiting” the tax deductions of the “wealthiest Americans.” That should bring in $300 billion over 10 years for the $635 billion Health Reserve Fund.
Obama is for the “public option” and individual and employer mandates (“bearing a responsibility to own health insurance”). Not mentioned in the speech is his new “openness” to the idea of taxing some people’s health insurance benefits for the express purpose of subsidizing insurance for others. John Goodman notes that the Obama campaign spent hundreds of millions of dollars attacking John McCain for proposing to tax insurance benefits. Goodman explains the differences in proposed changes to the tax treatment of health insurance.
The huge cost of workers’ health care was “a big part of what led General Motors and Chrysler into trouble,” Obama said. Thus, the cost of not enacting his plan is higher than the cost of passing it, he asserts.
Obama promises to help doctors by seeing to it that “doctors can pull up on a computer all the medical information and latest research they’ll ever need to know to meet patients’ needs.” (No need for patients to tell every doctor they see their medical history.) Instead of “piecework” payments, and yearly negotiations over the Sustained Growth Rate, he proposes to pay for patients’ overall health status. He’ll get rid of cost disparities, like those in McAllen, Texas, detailed by Atul Gawande in a much quoted article in The New Yorker.
In return, he needs the doctors’ help. “The fact is, Americans—and I include myself, Michelle, and our kids in this—we just do what you tell us to do.”
Obama promised that “if you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.” Same for “your doctor.”
He did not promise, however, that the price would not become unaffordable because of new regulations, such as guaranteed issue or community rating, or that the plan would still be available. Or that the doctor would still be in practice.
Congressmen, including Charles Rangel (D-NY), say the “overhaul” will definitely cost more than $1 trillion. Sen Orrin Hatch (R-UT), estimates that costs will exceed $1.5 trillion. Legislation being drafted by House Democrats will include $600 billion in tax increases and $400 billion in cuts to Medicare and Medicaid.(Bloomberg.com 6/12/09).
Additional information:
- AAPS congressional briefing 4/16/09.
- AAPS on Fox News 6/11/09.
- Kennedy releases draft “health care reform” proposal. AAPS News of the Day 6/10/09.
- Baucus proposing Hillary-redux only worse; Coburn and others propose Republican plan. AAPS News of the Day 5/30/09.
- Follow AAPS on Twitter at www.twitter.com/aapsonline.
I am a physician who specializes in the pathology of the skin. I make diagnoses on thousands of skin biopsies each year for patients who have melanoma as well as the commoner skin cancers, such as basal cell carcinoma and squamous cell carcinoma.
As bad as cancer can be, and it can be pretty damn bad (I have had it myself), it is not as bad as losing one’s freedom; it is better to die a free man than to live under (and accept) slavery. Better yet, however, is to see the death of bad government policy so that no one has to live under slavery. The real “cancer” American’s face in the realm of medicine, whether practicing it or receiving care from physicians, is the erosion of individual political freedom in medicine.
No amount of government intervention can “help” patients get better care; it can only make the care worse, by limiting access to physicians and causing physicians to retire early, or causing potential physicians never to enter the field.
Mr. Obama doesn’t realize this fact or he doesn’t care about freedom, or, in my opinion, both.
Three things physicians can do — as can any American who loves freedom — are the following: They can oppose the President ideologically on the issue of government’s further involvement in medicine, they can advocate the repeal of Medicare, and they can advocate the repeal of Medicaid. These three actions by physicians will go a long way in silencing Mr. Obama and moving the discussion to getting the government out of medicine completely — including the repeal the FDA.
Pres. Obama’s proposals are unrealistic. He may consider his approach to be worthy, but there is no way he can deliver all the things he has promised without extreme detriment to patients and physicians. In short, full implementation of what he proposes would further bankrupt the country, drive doctors out of medicine, and ration care to patients. We an only hope that there is enough public outcry and pressure and that there are at least enough Democrats in Congress who will understand the consequences and not let it happen (I’m not holding my breath). I’m almost 75 and still in full time practice. If things get too bad, it would be very easy for me to retire. Beyond that, I worry about my younger colleagues who are not so fortunate in this regard and wonder if there will be anyone out there to take care of me as the need arises.
NO HEALTH CARE REFORM WITHOUT TORT REFORM
I AM AN AMERICAN- BUT I WILL BE A COMPLETE DISSENTER AND NOT PLAY BALL WITH THIS CRAP IF THE LIABILITY ISSUE IS NOT REMOVED FROM THE EQUATION.
IF THE STUPID AMERICANS THINK THAT HEALTH CARE IS EXPENSIVE NOW– WAIT UNTIL THE GOVERNMENT MAKES IT FREE.
WHAT A JOKE !!
GIVE DOCTORS A TAX BREAK FOR ALL THE FREE CARE THAT WE GIVE OUT AND THEN YOU CAN DO AWAY WITH ALL OF THIS STUPID NONSENSE TALK
We are being set up by the King of Rhetoric.
He has until midterm elections to solidify his base and push us towards a european socialist style of healthcare, among other things.
DoctorSH
When Lyndon Johnson ramrodded Medicare through in the mid 1960’s,
the predicted costs proved to be a tiny fraction of what actually was and is being spent. There is no reason to believe that currently publicized cost projections will be any more accurate. The notion that an essentially bankrupt Government can do any better now, with fewer resources than it did then, is nonsense. The government will not be able to force competent physicians (those who are left) to work for a National Health Service because of the Thirteenth Amendment to the Constitution. The only people who get good health care will be using private practice physicians. American ingenuity and love of freedom will ultimately create a two tiered system. I pity the poor souls who rely on this (or any) Government for health care, or anything else.
Obama care is immoral.
Our country was founded on the principle of Individual Rights. The government’s sole proper function is protection of those rights.
Every individual adult has the sole responsibility for his own life in every respect including food, clothing, shelter and medical care. The incompetent are necessarily dependent on the voluntary charity of benevolent individuals able and willing to provide for them.
To live an adult human must be free to think for himself and act on his own thinking to bring those values into existence. If two individuals bring children into existence they are the responsibility of the parents until they become adults and able to care for themselves.
Every government program that provides any material value or service other than the protection of individual rights requires the violation of the rights of the individuals who created those values. In this context it either enslaves the creators of medical care including drugs, medical equipment , supplies and facilities and /or robbing the citizens to provide the money that government pays the producers of these values. Slavery and robbery are immoral whether actions of government agents or private individuals. Government robbery and slavery is infinitely worse.
Government interferrence in medicine is impractical, destructive, and immensely expensive but it will never be abolished until it is exposed as immoral.
Obama has missed the point. Doctors would be willing to give on some issues if a major detriment to the conscientious, efficient practice of medicine was removed.
Offer to pay primary care physicians who can offer the benefits of a medical home to their patients by direct contract, a set fee per month to provide the patient’s outpatient primary care, with a small scheduling fee per visit, and the patient’s finances would not be an issue at the time of the visit, and the doctor and his staff could concentrate on the patient’s clinical well-being. Allow some competition for the amount of the scheduling fee, depending on the basket of services offered in-office and doctors could compete on a level playing field, to provide more or less preventive and other services, as the local market demands.
Eliminate the RACs, the third party reviews, and the uninformed scrutiny by those who have no investment in the patient’s overall well-being, and then get out of the way and let us do the job so many of us have been doing for so many years despite the recent distortions that have only driven up our overhead, inserted a presence between the doctor and his patient that is welcomed by neither, and drained the joy of practice from record numbers of doctors, such that they now generally tell their kids to think long and hard before they ever consider a career in medicine.
Other payment reform initiatives like the Prometheus Payment Reform plan and others could allow doctors, including specialists, hospitals and other third parties to partner in sharing bonuses for targeted quality outcomes.
If the government was successful in getting quality outcomes by reviving a freer health marketplace as outlined above, doctors would choose to spend more time with government sponsored patients, and private insurers would have the option to earn patient loyalty by coming up with something better.
If we don’t remove the engendered fear that is a significant part of the design of the government’s current approach to health care providers, we will never reap the benefits of moving forward as partners to provide what our patients and our people truly need. Can we dare to hope?
I agree that ObamaCare is a disaster of major proportions. On a personal level, if this care plan was in place in 1999, my wife would not have been treated for her cancer and left to die. What kind of society is that!! Yet, one thing that is never mentioned: Where in any of the government style health plans is patient responsibility??? But why should I be surprised…..this administration and President have not taken responsibility for anything. They just blame the previous administration, Fox news and anyone else who is not on their side. They remind me of adolescents who have not matured.
Why were expenditures in McAllen Texas far above the national average?? Because it was the malpractice lawsuit capital of the US. Docs ordered every tests known to manknd for every complaint simply to be fully armed in court. Since tort reform in Texas, the number of lawsuits had fallen drastically and the disparity in spending is far less, but Obama didn’t cite the new data, as it didn’t suit his purpose.
No one in the media has identified the main two causes for rising costs. We can do more for more different diseases than ever before. We did not have CT, MRI, defibrilating pacemakers, ARBs, TZDs, PPIs, and “biologics” when I finished medical school (Cause 1). Thus, people are living longer than ever, and inevitably encountering more medical problems along the way (Cause 2). Are either of these things BAD?
Although not Greek, we as physicians and Americans should be aware of the ‘gifts’ Obama’s proposed plan provides: presently being paid (inadequately) for ‘piecework’ by Medicare, his suggestion to replace it with payment based on the total care of individuals is simply tantamount to becoming a salaried employee of the government. However, I read nothing in this account in which he describes the ‘cost-efficiency experts’, referred to in other reports, aka: the health board for rationing care who will micromanage the decisions we make for our patients.
His comments expressing his wish to only carry out the desires of doctors is ludicrous, and simply sardonic humor. If that were the case, why is he describing, rather than seeking our recommendations for, the elements of his future healthcare plan?
Human rights are subject to a zero-sum formula: it is impossible to provide the ‘right’ for healthcare to an additional 50 million without sacrificing the quality and accessibility of care for the remainder of Americans. With payment cutbacks in Medicare, does it not logically follow that the number of physicians accepting new Medicare patients will dwindle? What good is insurance if one has to drive several hundred miles to find a doctror who will accept it?
Obama makes Mr. Clinton look like a rank amateur as a mendacious politician. I say, ‘Caveat Emptor’!
We as physicians are being offered a remarkable opportunity to take back the profession and make it, well… professional. To that end we must, individually and collectively, realize that “the unconscious works for whoever is paying it.” If we sign managed care contracts, bill Medicare and Medicaid, prescribe off formularies, accept withholds and capitations, jump through arbitrary “medical necessity” hoops, conform our documentation to payor requirements, accept “employee” status, and otherwise sell our autonomy by, directly or indirectly, making our treatment decisions negotiable with anyone but our patients, we forfeit the right to the moral high ground we might otherwise take in the midst of the crisis in which we find ourselves.
If we are willing to make the necessary financial sacrifices now by making “the system” respond to the adoption of a profession-wide “fee-for-service” model as an ethical necessity for physicians to meet their moral obligation to advocate solely for the welfare of our patients, “the system” would be compelled to accept that we will negotiate for payment only with our patients, not their payors.
As a rule of “The House of God” might have been: “The patient is the one with the insurance.”
More Obama obstacles to good inexpensive health care.
The FDA is trying to ban pyridoxylamine, a cheap natural substance and an analog of vitamin B6, mandating the use of expensive prescription drugs by default. Obama can override such bans on useful natural substances but does not. Until this is openly explained, I cannot trust him.
More oversight committees will be necessary to carry out the Obama plan if it is approved. I hope he names two of them Welfarites Advocating Stimulating The Economy and Fund Recipients Augmenting Unrepayable Debt. (Watch the actonyms.)
Stop interfering with IV hydrogen peroxide in ambulances, as for stroke and heart attack patients, same for intravenous magnesium, or I will think the federal government is more interested in obstructing health than in assisting it. (My position on those two substances, though not common, is defensible in medical literature.) Obama is a full-fledged member of the Medically Organized Relying On Nonsense.