How AMA and Other Societies Abrogate Their Responsibilities

What blogs can do to help MDs regain ground:
1. Blogs geared for patients can help educate the public from the physician's perspective. Patients have very little idea of what the business challenges are that face physicians and how that impacts health care as a whole.
2. Blogs geared for physicians, by physicians, relating to the the most pressing practice management issues could have the same effect as a massive study group without the bureaucracy.
3. Blogs stimulate media attention which could help improve awareness of the increasingly vulnerable position medical practices are finding themselves in.
4. Blogs by health care experts, such as myself can help share valuable resources with physicians that were previously hard to obtain.

schwartzenegger's plan doesnt go far enough

what you can do to combat this is to put your money into lobbying for getting rid of private medical insurance entirely, and fight the real enemy of public health

or you can just stop being such a whiny bitch about 2% of your fucking income.

Nigel:

I went to medical school and training for 12 years. I take calls overnight every 4th night, in hospital, away from my family. I get calls from hospital regarless it's day or night. Someone without brain, just like yourself, in Detroit, who is unionized bolt screwer at GM gets paid 60-80k/year screwing bolts with full benefits, vacation days and retirement package. If doctor makes 200k (actually, most do much less), he has to buy malpractice, personal health insurance and have his own retirement financing.

I already do 20-50% of charity cases. Now I will have to pay to continue practicing medicine, to subsidize someone anencephalic like yourself?

I am from Soviet Union, and I can assure you that they did not tax rich. There were no rich. What they did, they just like Schwarzenegger, were deciding what to do for the people. Instead of people deciding what they have to do for themselves.

Also, please read the post. The question is what we should do with the physicians organizations who abrogate their responsibilities before their constituents, the doctors.

Now I admit that I haven't done the math on this one, or read the details of the plan, so I may be ignorant.

BUT

Isn't this a potential win for physicians? I mean, yeah, there's a lot not to like in this plan. but it preserves a role for private insurers and doesn't impose single payors and price controls, and it covers everybody, at least in theory. for me, it's a trade-off that makes sense.

For example -- if I am an ER doc hypothetically making $200K, I pay a $4,000 "tax" into this (which I presume will reduce my federal income tax liability). But as an ER doc, 19% of my patients are uninsured and pay me NOTHING as it is. So if those folks are compelled to get insurance, I recover anywhere from $10,000-40,000 in extra reimbursement.

I think there may be a lot to criticize, not least the question of "Will it work?" But from the physician's point of view, I'm feeling somewhere between wary and optimistic, not immediately opposed to it.

Maybe someone can educate me otherwise.

I'm glad to hear this issue voiced by Medgadget. I'm an AMA-dues paying primary care physician in the sub-urban midwest. Glad I won't have to deal with the state adding another tax to my income. (I think the inadequate reimbursement for Medicare and Medicaid patients is already tax enough.) I would much rather see the AMA and other organizations keep their thoughts to themselves than to publish drivel like this. It is easy to imaging some group of docs & bureaucrats spending a full day arguing about how to condense this down to a least-common denominator that benefits none.

Non-MD here, but from healthcare provider side of the fence. There are many problems with the Schwarzenegger proposal. Putting more financial constriction on health care providers already in short supply is antithetical to success.

The AMA and the American Nurses Association (ANA) have both suffered tremendous membership bleeds, and neither is powerfully positioned to advocate for its members in its present iteration. But with a fresh infusion of activist members and collaboration of the two organizations, there could be a much stronger voice advocating for physicians and nurses. Visit the blog Universal Health to read about how this could serve the interests of the 750,000+ physicans and 3 million registered nurses in the US.

Yes, the AMA has published its principles. But I think you should really read the Council on Medical Services report, located at http://www.ama-assn.org/ama1/pub/upload/mm/372/i06cms5.pdf

There you will find no mention of taxes on physicians, a position the AMA has taken when this issue has come up in the past. The AMA is a large organization and needs to make its responses carefully, which means thinking first before a knee-jerk reaction to say no. On the one hand there is a certain truth that getting some payment for the free care I currently give out will offset the "fee" California wants to impose, but I think that this is short sighted. Currently, many hospitals have to subsidize their physicians just to keep them on staff. I know that this is true of our practice. I could not afford to stay where I am without additional funds from the hospital.

I have every confidence that our AMA will come through for us. I call it our AMA because they are the only ones trying to defend what we do and improve the quality or our lives as physicians and our patient's health and safety.

If you have your doubts or disagree then you should come to the Annual Meeting in Chicago and participate as I do with the Organized Medical Staff Section. You don't even have to be an AMA member to participate in your first meeting. (You do have to be a licensed physician.)

Dr. L

Dr. L:

I don't have any confidence in AMA. It's been loosing ground among physicians in terms of membership, as we don't see it being proactive for us. It spends millions re-branding itself, its logo, its image. It pays handsomely to its bureaucrats. It spends millions on advertisements, jet trips, and conferences that produce nothing.

And at the time of nuclear bombs being dropped on MDs by Schwarzenkennedies, it comes out with its PC garbage, a "careful response."

I am still waiting for anyone to explain to me what all these "principles" mean. How about principles that say that American physicians will not take any intimidation? That if politicians think about levying taxes, AMA will call a strike? That in a market economy, no one has to pay for someone else, or their children? Etc, etc.

I am sick of this rotten AMA, and I can assure you millions of physicians are sick of it as well.

Since we already lost plenty of ground, what makes you think that AMA will "come through for us"? I say we need to either change it, or close this useless Chicago shop.

Former member of the AMA,

I'm not sure who here doesn't "get it." The system is broken and docs are part of that broken system (I am a licensed doc, BTW). My father was a GP before third party payers made all of our colleagues rich. It was a tough competitive environment in those days. Now all we need to do is stick something in an orifice and money comes out the other end. The AMA fought third party payers tooth and nail, although they wound up benefitting. Now we are blaming everyone else when a system fix comes along that hurts us. This is not an issue of political correctness. This is about trying to solve a problem. It will take all parties to do it. Your red baiting isn't very helpful, IMO.

How about some facts to inform this lively conversation. I am 40 and my wife is a physician. She still has
- $140K in student loans
- $100K more or less for starting her practice because the standard of care in the local hospital lawsuit inducing and she had a non-compete
- $120K in malpractice
- A barely averted 5% cut in Medicare reimbursement (probably will get enacted in 07)
- a 6.3% increase in operating and a 2% decline in revenue

At the same time
- Blue Cross Blue Shield has $865 million in reserves more than 3 months of expenses
- Between 2000 and 2004 Pennsylvania lawyers obtained fees on $2.01 billion in malpractice lawsuits

So physicians are NOT at the root of this problem. Politicians (see lawyers), lawyers, third-party payors, and bad policy is at the root of the problem. I will vote for a single payor system, Medicare's ability to negotiate drug prices, Medicare reimbursement permanently fixed to inflation, malpractice caps like in California, THEN I'll blame physicians (BTW, I am not a physician).

I'm with DrO.

PS I mean to say I'm with DrO. in the spirit of her post

alpo: I'm with you (single payor). I'm not sure that's what Dr. O. was saying, but if it was, I agree. Physicians are not at the root of the problem but they need to get onboard to helping solve it. I don't see complaining about a tax increase does that. Physicians are extremely well paid compared to everyone else and need to bear some of the weight, but not alone. We pay abnormally low taxes in this country and we get paltry return for it. 205 ofour tax money is used to kill people.

I am a physician but would gladly pay more for single payor. It will make everone's life better, including doctors' lives.

revere:

As Gerald Ford used to say, if you have gov't powerful enough to provide you with everything you want (i.e. single payer), you have gov't powerful enough to take away everything you have.

If 7 months waiting for CTs--just like in Canada--sounds like a good idea for your patients, it doesn't sound good for mine.

For you, it is "red baiting,' for me it is nightmares of my Soviet childhood.

P.S. you surely joking when you say "we pay abnormally low taxes"? There is no such a thing.

P.P.S. alpo: I am a boy.

MS-1, paramedic, and also someone who lived in the CIS 93-95.

We need universal health care. It makes sense. The Soviet Union did a lot of things wrong, but they are totally irrevelent to this discussion. Going striaght to totalitarian Communism every time someone wants to expand public services is no more rational than invoking Nazi Germany every time we buy a tank. All functional governments provide services to their citizens besides military protection. Europe provides much more than we do, and despite having fewer billionaires, their civilization shows no signs of desending into an Orwellian nightmare as a result.This is the real world, not a strict constructionist utopia.

The fact of the matter is that we have had universal heathcare in this country since EMTALA, and we will continue to have it until society is comfortable running credit checks on the parents of kids with pneumonia, and having security escort them out of the emergency room and off hospital property if they fail. I hope that day never comes.

While physician compensation is not at the root of the breakdown in heath care economics, uncompensated care and lack of vertical integration (without which treatment is far more profitable than prevention) is at the root of it. Those are the reasons why our system is so expensive, and its results, in terms of population health and well-being, are so medicore, despite the vast resources of technology and talent that everybody acknowledges it carries within it.

If physicians, as one of the major beneficiaries of the current system, need to sacrifice some of their highest-in-the-world compensation to address this problem, it is both morally necessary and in our self-interest to do so. Fighting against it is like fighting to keep control of your first-class cabin on the Titanic, post-iceberg.

Robert, I'd like to disagree with several points you made:
1) 'Invoking the Soviet Union is irrelevant to this conversation': Wrong. Dr. O and the other founders of this site have first hand experience of a socialist / universal system and thus their experience is intimately relevant. This is no different than a Canadian or British citizen commenting on the flaws of their health care systems. To discount this as irrelevant is naive and skirts the issue.

2) 'All gov'ts provide services': I think you missed the point of the previous quote that any gov't that can give you everything, is a gov't that can take away anything. Just as pts are 'getting free care' physicians are having their autonomy revoked. Don't believe me? Ask oncologists in England who can't give their pts new life saving drugs b/c the NHS has decided for budgetary reasons to prevent it. Or ask the Docs in Canada who are scrutinized if they see too many pts or are banned by law from practicing independent from the gov't.

Just b/c the gov't provides "services" doesn't give them a Right to provide any services. Especially when that requires the taxes of one to give to another. Was it Thomas Paine who said the gov't who governs least, gov's best? Milton Friedman, the Nobel Prize winning Economist, said it best in his book "How to Cure Health Care" when he said "why health care?". Why is healthcare the champion cause of the left? The poor need food more than they need doctors. They need clothes more than they need crutches? They need a home to go home to after they leave the hospital more than they need the hospital. Why don't we nationalize farms first, making 100% of farmers gov't employees, under gov't controlled price scales first. If that works, we'll move on. Oh wait, thats called Socialism / Communism when the gov't starts owning the means of producing economic goods.

3) Credit checks and security guards for sick kids? Melodramatic? Lets have a fair discussion of the topic. No one, in this post or any other, has suggested that.

4) "treatment is far more profitable than prevention" Yes & No. If you're going to throw out arguments, at least understand the real issue. Yes our country is in a tx not prevent mode. Why? B/c its hard to convince people to get preventative tx AND we can't prevent everything. Overall, w/ our DM, BRCA, Colon CA, Prostate CA screenings, PLENTY of $$ is being made off of screening tests. Hell, scopes are GI doc's bread and butter.
a) Prevention is profitable b/c you can sell prevention to anyone, you can only sell Tx to sick people.
b) Good health and cures for cancer are expensive, so who cares if "treatment is profitable". Profit is NOT an evil term and if you believe it is, you need to read Atlas Shrugged.

5) Physicians...need to sacrifice some of their highest-in-the-world compensation to address this problem, it is both morally necessary and in our self-interest to do so" Who gave you the authority to decide what is best for every doctor? If you want to donate 100% of your time, then feel free and congratulations. There's enough docs who care passionately enough about universal HC that they could probably cover the '46 million uninsured'. Oh what . . but then how will you feed your family? Don't assume what is right for you is right for every physician. Additionally, don't dare try to tell me what is moral for me to do or not do. You will lose that argument.

I challenge anyone to name one gov't program (besides defense) that has meet/surpassed its goals and expectations. Anyone thrilled w/ public schools? Ever been in a county hospital? Ever been in a private hospital? The free market is the answer plain and simple.

As P.J. O'Rourke once said,
"If you think health care is expensive now, wait until government gives it away for free."

The very idea that Arnold's plan could be seen as a win-win for physicians is laughable.

Once you involve the government in a problem, it's permanent. There will be no way to extract it from the situation, and it will, frankly, be a part of US healthcare forever, so long as the government remains afloat.

Just as we cling to a failing social security system when private accounts would make much, much more sense, so we'll cling to our "free" universal healthcare. Even when we see that the 5-year cancer survival rates in the UK are about half of what they are in the US for many a variety of cancer.

I question how this could affect research & development, as well. It's no mystery why the US puts out such a disproportionate number of new drugs in the world. Namely because there is a large profit incentive to do such. Strip that away with price controls (and those will happen), and what happens?

What's even more laughable is that our imbeciles in Washington are talking of legalizing 20-million people who frankly have no business being here and then throwing healthcare at them (to which they'll pay nothing). Anyone want to guess how many more unwanted souls are going to be showing up on our shores as a result?

Which also begs the question, do you really want people who view it as impossible to do something so basic as shut down the flow of illegals across our southern border in charge of your healthcare?

Finally, some one who gets it.