In the comments to Posting Number 55 of this series Quidpro and Dan S. debate what the effect of health care financing reform legislation will be on physicians and the willingness of persons to enter or stay in the medical profession. We will learn more over the weekend as doctors debate whether to ratify AMA support for the House Democratic bill.
Yesterday the AMA announced that it would support the House Democratic bill, the Affordable Health Choices Act of 2009 (H.R. 3962). James Rohack, AMA President, stated:
“On balance, H.R. 3962, The Affordable Health Care for America Act, is consistent with our principles of pluralism, freedom of choice, freedom of physician practice and universal access. It will significantly expand health insurance coverage to Americans to empower patient and physician decision making; institute meaningful insurance market reforms; make substantial investments in quality; institute prevention and wellness initiatives; provide incentives to states that adopt certificate of merit and/or early offer liability reforms, and reduce administrative burdens.”
“H.R. 3962 is not the perfect bill, and we will continue to advocate for changes, but it goes a long way toward expanding access to high-quality affordable health coverage for all Americans, and it would make the system better for patients and physicians,” Dr. Rohack said. "This is not the last step but the next step toward health system reform. We will remain actively engaged with patients, physicians, Congress and the administration to ensure that the final bill results in marked improvements to our health system."
AMA also called on Congress to pass the Medicare Physician Payment Reform Act of 2009 (H.R. 3961) to permanently repeal the broken physician payment formula and preserve access to care for seniors, baby boomers and military families.
If enacted the Democratic bill would achieve near-universal medical coverage through a combination of insurance regulation, individual and employer mandates with federal subsidies for low-income persons to purchase insurance, an expansion of Medicaid and CHIP, and increased taxes on the wealthy to pay for all this. Dan and Quidpro argue about whether or not this bill will drive persons out of the medical profession.
The Democratic bill (like the Republican bill, the Common Sense Health Care Reform and Affordability Act) fails to address the problem of SGR reform – which, if not addressed, would reduce physician fees under Medicare by over 20% next year and by additional amounts in succeeding years. I assume that the AMA endorsement of the Democratic bill H.R. 3962 means that there has been a promise that SGR reform, H.R. 3961, will be swiftly enacted. But the question remains, will doctors come out ahead or behind under these new laws?
Noam N. Levey and Bruce Japsen of the Chicago report that some physician groups intend to challenge the AMA's decision in a meeting of the House of Delegates on Saturday. Quoting the dissenters, the reporters state:
"These bills go far beyond what is necessary to fix what is broken with our health care system, and they grant the federal government considerable new powers and authority, which could ultimately amount to a complete government takeover of health care and which is anathema to doctors and patients," a resolution introduced by the American Association of Neurological Surgeons, the American Society of General Surgeons and the American Academy of Facial Plastic and Reconstructive Surgery. The resolution also was supported by AMA delegations from George [sic, Georgia] and the District of Columbia.
I think it is notable that the specialist groups which are opposed to the Democratic bill are all surgeons. Under the reform bill payments under Medicare and Medicaid will be redirected away from specialists and towards primary care physicians, and there will be funding to encourage the entry of physicians into primary care. Surgeons are also more likely than primary care physicians to be liable for increased taxes under the Democratic bill.
The weekend vote by the AMA House of Delegates on the surgeons' resolution should be instructive.
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Maybe it's those same surgeons who cut people's feet off for increased profit, like Obama said.