AMA past president letter is both bizarre and helpful

Three past presidents of the AMA penned an interesting letter to the Washington Times on 7/23. 

The past presidents start with a series of indefensible statements like:

"We have the best health care system in the world." [Unless you count being last or near last on the list of quality of care, affordability, percent of people with chronic conditions who can't take medications as prescribed due to costs.  See Commonwealth Fund reports.]

"...the vast majority of [Americans] are satisfied with the coverage they have..." [Only if you fail to ask a representative sample of Americans about affordability, limits placed on choice, ubiquitous waits & delays, and more. Better look at those reports again.]

They parrot talking points that seem to have come right out of the boardrooms of the insurance industry and their PR firms bent on maintaining the status quo at all costs.

What I find quite odd is discovering that I agree with the authors on the three key points they want from Congress:

First, we should expand the choices of types of plan and access to primary and specialized care.  [Yay!  A public option that adds choice and access!  I agree!]

Second, every American should have the opportunity and the responsibility to choose and own the insurance plan that meets their needs and those of their family, with the periodic right to change if dissatisfied with the previous choice. Because the beneficiary owns the coverage, it is totally portable and not locked to specific employment.   [Not locked to specific employment, plans that meet individual and family needs - that's what the President has been describing.  We agree again!]

Third, whoever puts up a subsidy (defined contribution) for the purchase of the insurance should put up the same subsidy, no matter what choice the person makes. [Sounds like an argument for a defined set of basic benefits that doesn't vary by insurer/employer/prior condition - I love it!]

If they want these things then they - like I - believe the status quo is not so good.  Bravo!  I can support these points.  I'm glad to find that they are included in the bills working their way through Congress right now. 

Odd that the letter is in opposition to the bill, but I suppose that could be corrected if these past AMA presidents sit down with folks in Congress and engage in a discussion on what we can do to change the status quo.

Remember who wins the status-quo game. 
Not our patients. 
Not all the small and large businesses swamped with health care premiums or unable to afford any health coverage for their employees.
Not the American taxpayer. 
Not the 45 million Americans with no health coverage. 
Not the 26 million additional Americans with health coverage they can't afford to use. 
Not the 50 percent of people who file for personal bankruptcy because of medical debt (75% of whom had insurance at the time)
Certainly not those of us on the front lines of health care struggling to survive in this oh-so-wonderful status quo environment.

I don't know what the future will bring, but the status quo holds no charms for me. 
The status quo is broken.

I am thrilled to be part of a small but growing community of health care professionals who have chosen to risk much in pursuit of the care our patients want and need and the careers we thought we would have when we entered medical school.

Effective primary care is the heart of any high performing health system.
Our contribution to framing reform helps make that reform better.
No solution will be perfect, but any solution would benefit from our involvement and diminished by our absence.
We should continue pushing back against this messy non-system, but we have a chance to also work within the system to change it. 
That chance may be slim and the risks may be great, but to deny ourselves even the slimmest chance would be a shame.

I'm willing to speak out against reform that stifles innovation, choice, freedom, care, outcomes, but I'm also willing to speak up for our patients, to speak for reform that inspires and supports innovation, choice, freedom, care, outcomes.

I'm glad the past presidents of the AMA articulate the key changes they want to see.  The status quo does not serve us or our patients.  It is time for change. 

L Gordon Moore

Comments

[jean]

Drs Sh and G
Catastrophic insurance is a good idea but ignores most of the care that most people need if people cannot get access to prevention education rehabilitation planning advice and coordination then more catastrophic care will be needed driving up costs yes?

This focus on the financial model disregards patients entirely and once again puts them as pawns and consumers pitting dollars against products they "buy". Health care does not work like this.

Current arguments seem to center on who gets control of healthcare -the government or private interests? The right answer is that this is the wrong question.
Those who favor non governmental control seem sure that if we just tweak this or that just right we can make health care's round peg fit into the square hole of models used for purchasing other goods and services.
Those who favor governmental control seem to think that this is the ideal single payor integrated network of our dreams.
Seems to me that it isn;t either /or and there are lots of possibilities for organization. But am I hearing anywhere from the current bills that there is to be reorganizing of the structure in which i work?I desperately need an organized system in which everyone caring for patietn and the patients themselves could see information on a common platform, and i need a system where specialists and PCPS, allied health and Pharmacy, home health and hospitals are not fighting at each others throats about paper work and dollars. I fear that no legislature can get at that

[Gordon Moore]

DoctorSH
Good suggestions deserve to be tested so that we can have the best possible chance of achieving our desired results.

I like the idea of catastrophic health insurance for all - it certainly seems like it would help reduce or even eliminate the medical bankruptcy problem.

I love the idea of more competition for insurers, right now they seem to dominate local markets.

I understand that the data on tort reform are mixed - might help, might not. Probably deserves further trial and study.

I like your steps, but I believe we need more. The concerns you raise regarding the government takeover of health care was raised in the 1960s regarding Medicare. Fifty years later we can still choose to opt in or opt out. You are the perfect counter-argument in that you were not forced to remain in the government system, not forced to even continue taking insurance.

We disagree on the degree to which we ought to fear a gov't takeover of health care. We agree that something should be done. I suspect we agree on a lot more than we disagree.

Let's keep fighting for what's right for our patients and against a system that has systematically tried to exterminate the professional in both of us.

Gordon

[DoctorSH]

Gordon:

Almost everyone can agree that the status quo no longer works, and that we need reform.

But what type of reform and who keeps control of healthcare? The present reforms going thru Congress are top heavy with too much government intervention. Why would a new govt option work any better at keeping costs under control than Medicare and Medicaid do at present? In short, they won't and are doomed to fail.

A public option has future consequences. The most dire being movement of the majority of indivduals into a govet run plan. These plans will be under govt control, and by that I mean bureacratic control and cost controls. If you think getting a precert or referral from a health insurer is bad now, try getting one from the govt.

Let's fix the system in steps.
1) Catastrophic insurance for everyone- thats a less expensive mandate and would prevent medical bankruptcy.
2) Allow private contracting outside of Medicare. This free market initiative would bring costs down and innovation up.
3) Allow purchasing insurance across state lines. This heats up competition among insurers.
4)Tort reform would decrease defensive medical practices

There are many others that would work and keep medical decisions solely between a doctor and a patient. The present reform proposals do the opposite and I can not support it.