In a letter to Senate Majority Leader Harry Reid (D-NV), AMA Executive Vice President Michael Maves, while withholding endorsement, expresses support for many features of the bill:
- Huge premium increases for some. The AMA supports guaranteed issue, modified community rating, removal of limits on pre-existing conditions, and “nondiscrimination based on health status.” All of these will increase premiums to young, healthy, responsible individuals, and will basically outlaw true insurance, which offers premiums based on risk. Young, healthy workers will be overcharged to subsidize older people who have had much more time to increase their earning ability and to accumulate assets. This will rob the young and limit their ability to get ahead. A healthy 25-year-old could see his premiums triple (Business Journal 11/6/09).
- Wealth redistribution; decreasing incentives to work. Refundable tax credits based on income to help cover premiums are a form of forcible wealth redistribution. The arbitrary income thresholds translate into very high marginal tax rates on those striving to pull themselves out of poverty by working harder or gaining skills.
- Limiting choices of seniors. The plan would reduce “overpayments” to Medicare Advantage plans, with “overpayment” being undefined. While AAPS takes no position on the desirability of Medicare Advantage plans, the fact is that some 25% of seniors have chosen them for the richer benefits that they offer. The result of making these plans less attractive or available will be to increase the demand for Medigap plans sold by AARP—the AMA’s partner in advertising for “reform.”
- Limiting choices for everyone. The health insurance exchanges, which are supposed to “offer more affordable choices,” are modeled on the Massachusetts Connector, which has the effect of restricting choices and increasing cost through expensive mandates.
- Expanding dependency on Medicaid. Provisions to “enhance” Medicaid coverage mean expanding Medicaid coverage, placing more burden on states that are already being bankrupted by it. Being forced onto Medicaid restricts patients’ options to the diminishing number of physicians willing to accept Medicaid.
- Increasing costs, and shifting resources away from sickness care. Coverage for “prevention and wellness initiatives” without copayments or deductibles will guarantee increased costs, by removing the most effective utilization control mechanism, with little to no proven benefit. It will also increase incentives to shift efforts away from the more difficult work of caring for the sick.
- Decreasing physician autonomy. There is no evidence that spending $1 billion on “comparative effectiveness research” will “enhance patient-physician decision making about treatment options.” In fact, it will increase pressure on physicians to conform to government-approved protocols.
Even in its proposed “improvements,” the AMA accepts, in principle, the central planning, price controls, and expanded government intrusions in the bill. It is apparently willing to accept the abolition of true insurance, a virtual government takeover of the practice of medicine, and the socialist principles of wealth redistribution and compulsory “insurance” for a small increase in physician payments and a slight easing of the most onerous regulatory requirements.
AMA has not even taken notice of some of the very worst provisions of the bill, noted by AAPS physicians and others in our virtual reading room.
The “administrative simplification” provisions—apparently the huge new regulatory apparatus created by HIPAA ostensibly for this purpose isn’t enough—will likely provide more profit-making opportunity for the AMA to produce codes and compliance materials.
Additional information:
The biggest problem on hand now is the HITECH (Health Information Technology for Economic and Clinical Health Act.
Under this new monestor that no one knows how it is going to hurt, each person or entity in the business of healthcare needs to have a “Business Associate Agreement” with the other person or entity.
Whenever there is an agreement there is a liability and lawyers…More so in our litigatory enviroment
Now, Insurance companies are sending out agreements written in a way to shift the burden of the liabilities on the physician in case of litigations related to this new law (HITECH)
Does anyone know how to face this new threat?????????
I am surprised not to see the Fact that the TMA (Texas Medical Association) has come out against the Senate Bill. If I missed it i am sorry,
This convey’s a strong message to the AMA that State Societies may become not unified with it.
If most of the state Societies can reject this Senate Bill then it should be Publically Annouced. What is the poistion of the SMA? Should member dues be paid to the SMA instead of the AMA.?
Don Iden M.D.
Lifetime Member of AMA, TMA & Nueces County Medical Societies
Lifetime Member of the American Academy of Dermatology
FAAD,FABD,Mayo Clinic Alumnus, Mayo O’Leary Society
The essence of this horror is collectivism. America is the nation founded on the principle of Individual Rights. Only individuals have rights. There is no such thing as group rights. Every adult individual is responsible for himself in every respect including his health. Children are the chosen obligation of their parents until they become adults and gain the ability to care for themselves. Those individuals who are unable to care for themselves are in justice dependent on the voluntary charity of those willing and able to provide it. In a nation that understands these principles there is no army of incompetents and free loaders. Most Americans are proud and independent as there lives demonstrate. The evil moral code of altruism is holding them back from asserting themselves by demanding that the government leave them alone in the realm of productive work and perform one task only, the protection of the individual rights of every individual American. Only a principled opposition has a chance of turning back the progressive march to a tyranny in America that controls every aspect of individual lives.
What we have in the making is a hostile takeover of the healthcare industry by the Administration and Congress. Less than 30% of Americans are in favor of this monstrosity or any form of it. This legislation is a failute in all three of its stated (bogus) goals- increased access, decreased cost, and insurance for all (13 million still uninsurred). My great frustration is that we as physicians are unable to mount a national, coordinated campaign to educate the public and pressure Congress in such a way that they realize the cost for the Nation is too high to fall into the party line. What an irony for the President to hold a job summit while proposing this huge job destroying piece of legislation.
We are about to see the deconstruction of the finest healthcare available in the world. We all agree the system needs reform, but the government does not have the answer to fix the system while preserving the doctor-patient centered care- they have bankrupted the insurance they have- Medicare and Medicaid. What insanity!
It is hard to believe what is going on in Washington. Everything being done is going to hurt the people and the economy. I cannot fathom WHY? Can they not see what is going on. The district of columbia has become the district of crazy ideas. The people are more afraid of what is going on than we were in World war 2 or the entire cold war. We knew we would win but it would be difficult. Now we do not know. How do we stop them. The elections in 2010 will get rid of most of them but by then it may be to late. It is hard to believe how dumb or sick or insane things have gotten.