By Lisa Schencker
Chicago Tribune, June 10, 2019
Doctors gathered in Chicago for the American Medical Association’s annual meeting this week are increasingly finding themselves at the uncomfortable center of a national debate over “Medicare for All.”
A group of doctors, nurses and medical students protested the meeting, criticizing the association’s opposition to Medicare for All — the idea of expanding Medicare to cover all Americans. And on Monday, the doctors at the meeting heard a speech by Seema Verma, head of the federal Centers for Medicare & Medicaid Services, a Trump appointee who devoted a chunk of her talk to what she sees as problems with the proposal.
She told the audience, to applause, that Medicare for All would lead to higher taxes, lower payments for doctors and rationing of health care, among other things.
“We are deeply committed to helping those who need it, but while doing that, we must put the patients and their doctors in the driver’s seat to make decisions about their care, not the government,” Verma said.
So far the AMA has stood by its opposition to Medicare for All, also sometimes referred to as a single-payer system or universal health care, even as it’s become a hot topic ahead of the 2020 presidential race. Democratic candidate Sen. Bernie Sanders, I-Vt., unveiled a bill earlier this year to move to a single-payer health care system. About 56 percent of Americans surveyed earlier this year by the Kaiser Family Foundation said they would favor all Americans getting their insurance from a single government plan.
Supporters say they’re weary of the growing costs of health insurance, provided by private insurers, and restrictions often placed by insurers on which doctors can be seen and what will be covered. Those opposed to the concept, such as the AMA, say choice is key to health care improvements, and they worry about the government’s ability to effectively administer and fund such a huge system.
“The AMA is absolutely in favor of having every American have health care that needs to be of good quality and affordable,” AMA President Dr. Barbara McAneny said in an interview. The AMA supports the Affordable Care Act, also known as Obamacare, which mandated that all Americans have health insurance and barred discrimination based on preexisting conditions, among other things. “We just aren’t certain that Medicare for All is the right vehicle.”
McAneny said the association shares the frustration many feel with the current health care system, saying, “We cannot continue to spend this quantity of money and create bankruptcies just because someone gets sick.”
But the association believes choice in health care is a better way to go than Medicare for All. McAneny worries about what might happen to a government-run health care system during government shutdowns and about whether it would pay enough to sustain medical care. Now, government health insurance programs Medicare and Medicaid tend to reimburse doctors less than private insurers.
McAneny runs a cancer clinic in New Mexico, where most of her patients are on government health care programs. “I struggle to keep that practice breaking even,” she said. “If I did not have the higher rates of commercial payers to make up the shortfall of what I’m funded for Medicare rates, I would end up having to close that practice and leave a lot of people without service.”
Still, proponents of Medicare for All call the association’s stance antiquated. The group Physicians for a National Health Program protested the association Saturday over its position, shouting “AMA, get out of the way!”
That group contends that without private insurance, hospitals and doctors wouldn’t have to spend as much on administration, freeing up dollars for care. It also wants the AMA to stop being a member of a group that opposes single-payer health care called Partnership for America’s Health Care Future, which includes as members the Blue Cross and Blue Shield Association and the insurance industry’s main lobbying group.
The physicians’ group also notes that many doctors support the concept, pointing to a 2017 survey by physician search firm Merritt Hawkins that found 56 percent of doctors surveyed either strongly or somewhat supported a single-payer health care system.
“It makes the AMA seem awfully out of touch not only with the public but with the physicians they represent,” said Dr. Philip Verhoef, a physician at University of Chicago Medicine, and a member of the national board of Physicians for a National Health Program.
Chicago physician Peter Orris would also like to see the AMA reverse course, saying he believes that Medicare for All would remove unnecessary administrative costs from the system.
Still, Orris remains a member of the AMA despite his differing views from the group. Orris is a professor of occupational and environmental medicine at the University of Illinois at Chicago and a practitioner at the health system’s hospital.
“How are you going to bring everybody along there unless you’re engaging in that debate?” Orris said.