PNHP

Why I won’t join the American Medical Association

Archives for 2008

Why I won’t join the American Medical Association

by donag
Daily Kos
Sat Nov 22, 2008 at 11:17:57 AM PST

I read the 2008 AMA Reform Proposal. As a result I sent an unsolicited comment to their Member Center. I thought I would share this with you. It was longer than their 1,000 characters and couldn’t contain non-alphabeltical characters (e.g. hyperlinks), so I sent them part 1 and part 2.

Comment: Part 1. I have not joined the AMA in the past 18 years of medical practice for 3 reasons:

1. not subscribing to a single-payer/universal access health care insurance system.

2. poor ethics of the AMA in terms of receipt of outside sponsorship

3. putting the profession in a bad light with its unseemly lobbying on The Hill in concert with Big Pharma and HMOs/insurance industry.

The 2008 AMA proposal on reform is too little to late. It does not focus on universal access, affordability or quality. It is just another way of maintaining high fees for physicians who do procedures and benefits its unholy association with big pharma and HMOs/insurance industry.

Comment: Part 2: I am a local leader in healthcare and will not endorse your organization, but will continue to advocate for Physicians for a National Health Program. It is my advice to my colleagues to support that organization and not the AMA who are now one of the biggest obstructions to healthcare justice. I am unable to include hyperlinks to some excellent critiques of your Proposal on Reform in this note as you can’t include non-alphabetic characters.

I will continue to watch future AMA proposals, but it is time the AMA stopped this PR approach to their tarnished image and proposed some real healthcare reform.

Why I won't join the American Medical Association

by donag
Daily Kos
Sat Nov 22, 2008 at 11:17:57 AM PST

I read the 2008 AMA Reform Proposal. As a result I sent an unsolicited comment to their Member Center. I thought I would share this with you. It was longer than their 1,000 characters and couldn’t contain non-alphabeltical characters (e.g. hyperlinks), so I sent them part 1 and part 2.

Comment: Part 1. I have not joined the AMA in the past 18 years of medical practice for 3 reasons:

1. not subscribing to a single-payer/universal access health care insurance system.

2. poor ethics of the AMA in terms of receipt of outside sponsorship

3. putting the profession in a bad light with its unseemly lobbying on The Hill in concert with Big Pharma and HMOs/insurance industry.

The 2008 AMA proposal on reform is too little to late. It does not focus on universal access, affordability or quality. It is just another way of maintaining high fees for physicians who do procedures and benefits its unholy association with big pharma and HMOs/insurance industry.

Comment: Part 2: I am a local leader in healthcare and will not endorse your organization, but will continue to advocate for Physicians for a National Health Program. It is my advice to my colleagues to support that organization and not the AMA who are now one of the biggest obstructions to healthcare justice. I am unable to include hyperlinks to some excellent critiques of your Proposal on Reform in this note as you can’t include non-alphabetic characters.

I will continue to watch future AMA proposals, but it is time the AMA stopped this PR approach to their tarnished image and proposed some real healthcare reform.

Uwe Reinhardt on indefensible administrative costs

Why Does U.S. Health Care Cost So Much? (Part II: Indefensible Administrative Costs)

By Uwe E. Reinhardt
The New York Times
November 21, 2008

In my previous blog post, I showed that America suffers from “excess spending” in its health care system. Here I will discuss one factor that drives up that spending: indefensibly high administrative costs.

To review: “Excess health spending” in this context refers to the difference between what a country spends per person on health care, and what the country’s gross domestic product per person should predict that that country would spend. (The prediction is based on trends in other countries in the Organization for Economic Cooperation and Development.) The word “excess” here should not be taken as “excessive” unless one could demonstrate that what the other O.E.C.D. nations spend is appropriate and what we spend is ipso facto wasteful.

The United States spends nearly 40 percent more on health care per capita than its G.D.P. per capita would predict. Given the sheer magnitude of the estimated excess spending, it is fair to ask American health care providers what extra benefits the American people receive in return for this enormous extra spending. After all, translated into total dollar spending per year, this excess spending amounted to $570 billion in 2006 and about $650 billion in 2008. The latter figure is over five times the estimated $125 billion or so in additional health spending that would be needed to attain truly universal health insurance coverage in this country.

One thing Americans do buy with this extra spending is an administrative overhead load that is huge by international standards. The McKinsey Global Institute estimated that excess spending on “health administration and insurance” accounted for as much as 21 percent of the estimated total excess spending ($477 billion in 2003). Brought forward, that 21 percent of excess spending on administration would amount to about $120 billion in 2006 and about $150 billion in 2008. It would have been more than enough to finance universal health insurance this year.

The McKinsey team estimated that about 85 percent of this excess administrative overhead can be attributed to the highly complex private health insurance system in the United States. Product design, underwriting and marketing account for about two-thirds of that total. The remaining 15 percent was attributed to public payers that are not saddled with the high cost of product design, medical underwriting and marketing, and that therefore spend a far smaller fraction of their total spending on administration.

Two studies using more detailed bilateral comparisons of two countries illustrate even more sharply the magnitude of our administrative burden relative to that in other developed countries.

One of these is an earlier McKinsey study explaining the difference in 1990 health spending in West Germany and in the United States. The researchers found that in 1990 Americans received $390 per capita less in actual health care but spent $360 more per capita on administration.

A second, more recent study of administrative costs in the American and Canadian health systems was published in 2003 by Steffie Woolhandler and David Himmelstein in The New England Journal of Medicine. The study used a measure of administrative costs that includes not only the insurers’ costs, but also the costs borne by employers, health-care providers and governments – but not the value of the time patients spent claiming reimbursement. These authors estimated that in 1999, Americans spent $1,059 per capita on administration compared with only $307 in purchasing power parity dollars (PPP $) spent in Canada.

More and more Americans are being priced out of health care as we know it. The question is how long American health policy makers, and particularly the leaders of our private health insurance, can justify this enormous and costly administrative burden to the American people and to the harried providers of health care.

http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/?scp=2&sq=Uwe%20Reinhardt&st=cse

Comment:

By Don McCanne, MD

Professor Reinhardt already said it: “More and more Americans are being priced out of health care as we know it. The question is how long American health policy makers, and particularly the leaders of our private health insurance, can justify this enormous and costly administrative burden to the American people and to the harried providers of health care.”

Yikes!!! I’m a Slave to Socialized Medicine

by: Steve Weissman
t r u t h o u t | Perspective
Friday 21 November 2008

http://www.truthout.org/112108A

Growing up in Florida in the 1940s, I saw many of the doctors my family knew fighting against Harry Truman’s effort to enact what they called “Socialized Medicine.” Their immediate target was Sen. Claude Pepper, a New Deal Democrat who supported universal health care. Our doctor friends dubbed him “Red Pepper” and helped defeat him in the elections of 1950. Yet, for all this early “fight for freedom,” I now find myself in France enjoying single-payer, socialized medicine, which I would heartily recommend to all Americans.

The system here is surprisingly nonbureaucratic, at least for the patient. My wife Anna and I picked our own general practitioners (GPs), specialists and hospital care, with no insurance company restricting us to their list of doctors or hospitals. In fact, we found only two restrictions. The GPs could turn us down if they already had too many patients and they had to be within our geographical area so they would not have to travel too far when making a house call. Yes, under socialized medicine here in France, doctors still make house calls, even here in the boondocks where we live.

Nurses also make house calls to give shots or take blood for testing. Test results usually arrive in the next day’s mail.

For each visit to the GP, we write a check for 22 euros. The system then reimburses us for 70 percent with a direct deposit to our bank account. For some particularly debilitating conditions, the government system pays the full 100 percent. To pay whatever the government doesn’t, most people here have private top-up insurance, which is very reasonably priced. So, the single-payer system has more than a single payer, but the insurance companies exercise none of the control they would back home.

At the pharmacy, we don’t pay at all. We simply present our health service cards: the government and top-up insurance then pay the pharmacist directly. The system excludes certain nonnecessary medicines and requires that we use generic medicine when available.

For most visits to specialists, test facilities or hospitals, the GP acts as a gatekeeper, writing prescriptions and often a letter explaining particular problems. He or she does all this on the spot during office visits, and there’s none of the paper shuffling one sees in doctors’ offices everywhere in America.

Most specialists and test-givers also write up their reports on the spot and hand them directly to the patient, though x-rays and other test results will soon be transmitted to the GP by computer. Again, we’ve seen very little bureaucracy and no interference by either the government or insurance companies.

None of this is free, of course. Everyone in the workforce pays a percentage of their taxable income to cover this, their pensions, and other social charges. For Anna and me, the costs are covered by our British pensions from the time we lived and worked in England.

How good is the French medical care? Surveys by the World Health Organization rate the French system as the best in the world, and far better than average health care in the United States. Life expectancy and most other relevant rankings are also higher in France than in the United States.

From our own experience, we would agree that French medicine is much better and far cheaper than in the United States. When we lived in Florida, my very expensive heart specialist seemed content for me to have a bit of high blood pressure, which he saw as natural for a person of my age. Not so here in France, where the doctors kept changing my pills until they got me down to the normal 120 over 80. The French doctors also found a way to end a long-standing enlargement of my heart that never bothered my American doctors.

To be fair, not all doctors here are as good as the ones who’ve treated us, and we’ve heard the same kind of horror stories we heard in the States about doctors who buried their mistakes. We also hear threats to cut back funding, which is already far less per head than spending on medical care in the United States. But, so far, we’ve gotten the best of care, as do all our neighbors, including workmen, farmers and retirees on limited budgets.

Why, then, can’t Americans have the same kind of socialized medicine? Mostly, because of the health maintenance organizations and insurance companies, who take such a big slice off the top. So strong is their influence that almost no one of any clout in American politics dares to talk of a single-payer system that would simply do away with private medical insurance, except perhaps as the kind of top-up they have here.

Hopefully, if enough Americans get to know what exists here in France, the debate will open up. Something like the French system would certainly save Americans a great deal of money and provide much better care.

But, for Anna and me, it’s already too late. We’ve become so enslaved by the great medical care we now have that we cannot see ever moving back to the United States or anywhere else. That, I suppose, is the true horror of socialized medicine that all those Florida doctors warned about back in the 1940s.

A veteran of the Berkeley Free Speech Movement and the New Left monthly Ramparts, Steve Weissman lived for many years in London, working as a magazine writer and television producer. He now lives and works in France.