THE TREATMENT JULY 16, 2009
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Via Health Care for America Now: The American Medical Association just sent a letter to House Ways and Means Chairman Charles Rangel, endorsing the health reform proposal put forward by three House committees.
This is unexpected. Or, at least, I wasn't expecting it. Recent signals from the AMA suggested they were reluctant to embrace reform, in no small part because they believed a public insurance option would underpay them. But the AMA letter contains no caveats. It is a straightforward endorsement.
And that makes it a pretty big deal. No, the AMA is not as powerful, nor as representative of the medical
community, as it once was. But an unqualified endorsement for the most liberal plan out there has large symbolic value, given the role AMA
played in killing health care reform for most of the 20th Century.
So what's in it for the docs? The medical community came into this debate with two big concerns. One is the financial and emotional burden of malpractice lawsuits. The other is the annually scheduled reduction in Medicare payments, known as the Sustainable Growth Rate (SGR) formula, that the AMA and other physicians lobbies end up fighting every summer when it's about to take effect.
SGR, at least, has very much been on the table, as readers of this blog may recall:
Over the past few weeks, according to
sources, House committee staff have been involved in serious
negotiations with representatives of various physician groups,
attempting to win their overt support not just for reform but for a
public plan option specifically. As an enticement, they've been
promising to fix permanently the SGR problem--that is, the annually
scheduled adjustment to the "sustainable growth rate" in Medicare,
which threaten increasingly large cuts in physician payments before
Congress inevitably postpones changes for a year. Reformers, including
President Obama, have already talked about doing this; apparently, the
offer the House Dems are making is to follow through on this and to
make it a good, solid fix.
And, sure enough, the AMA talks about the SGR fix in its letter, endorsing reform that:
Recognizes that fundamental Medicare reforms, including repeal of the sustainable growth rate formula, are essential to the success of broader health system reforms;
(Emphasis mine.) Changing the SGR is expensive, probaby $200 to $300 billion over the course of ten years, depending on the details. And that's on top of the cost of expanding insurance coverage. But, to be clear, the SGR adjustments were becoming a farce. If they are part of a package that includes payment reforms designed to improve quality and reduce health care costs over the long run, it'd be money well spent.
As always, I may revise that judgment as other people who are part of this debate get back to me with their thoughts.
--Jonathan Cohn
7 comments
THE AMA COMES AROUND.... About a month ago, the American Medical Association announced that it would oppose any health care reform effort that included a public option. This was not unexpected -- the AMA has a lengthy record of opposing...
- Anonymous
July 16, 2009 at 1:46pm
The healthcare situation changes rapidly, as I've noted before, and I won't fill you in on every
- Anonymous
July 16, 2009 at 3:03pm
the 2000 pound gorilla in the room is still Tort reform
- davidlheber
July 16, 2009 at 4:55pm
Is there any evidence that tort reform at the state level (passed in several states) has ever lowered insurance rates? The data is conclusive in NJ - rates went up.
I'm open to real data - not proclamations - about other states, I know Texas and I think Washington? also have state level laws in place. But I haven't seen anything that empircally proves that tort reform lowers rates. Please link if so.
- Wandreycer1
July 16, 2009 at 5:27pm
Also just in: Ron Paul avers that healthcare is "not a right". Something tells me, though, that if he weren't rich and didn't have the great insurance that goes with being a congressman, he'd do a complete 180 on this. Anyone wanna bet differently? Didn't think so.
- kevincollins
July 16, 2009 at 5:34pm
Right shmight, such a dodge.
The present system serves noone well - doctors, nurses, patients - except insurance executives and it's bankrupting us to boot. I'd like the right to not to circle the drain economically if we have a fighting chance to stop it.
Admittedly, I personally have no problem with putting the insurance companies out of business (although no such thing will remotely happen) so I guess I should come clean on that. Let those bloodsuckers get real jobs, I have no patience with corroding our whole system so they can continue to make money off sorrow with a bad product. Let freedom ring, my fat arse.
- Wandreycer1
July 16, 2009 at 6:02pm
To Wanderycer1: The real cost of current malpractice laws is not merely the high malpractice insurance premiums, which account for only 1-2% of healthcare costs. Rather, American doctors practice perhaps the most defensive medicine in the world, and this is largely due to the state of malpractice law.
Doctors regularly order tests for CYA (cover your ass) with the understanding that if they didn't order the test and said patient was the 1 in 10,000 they could be sued for millions and have a mark on their record, depending on the jury. Some of these tests cost thousands of dollars, and it adds up quickly, dwarfing any direct costs of malpractice.
Put yourself on the doctor's place. Chances are you were a workaholic A student premed, spent 7-12 years after graduating from college in medical school, internship, residency, and fellowship and got 100-150K in loans. You become very risk averse. If a patient wants a stupid expensive study and you know malpractice cases are not
- lsokol
July 16, 2009 at 10:35pm