Predictable.

Wiki has a pretty good run down of their long anti hippocratic oath history. Fought medicare tooth and nail for one thing.

http://en.wikipedia.org/wiki/A…..ssociation

There must be a pen shortage, and doctors are worried without freebees from Glaxo-Smith-Kline-Phizzler-MuckMuck-LeRoach, they may have to buy thier own. (Or pay for thier own trips to Hawaii for “Continuing Ed”.)

Thank you for this post.

” These were among 8,700 trips by Department of Defense personnel paid for by the health care industry — at a cost of more than $10 million — from 1998 through 2007, according to an analysis by the Center for Public Integrity. In a joint project with Northwestern University’s Medill School of Journalism, the Center examined 22,000 travel disclosure forms filed by DOD personnel, and found that the medical industry was by far the biggest sponsor of free travel, accounting for about 40 percent of all trips. The sponsors included not only drug and device makers but also health foundations and trade groups often funded by those companies.

Of special interest to the industry were DOD employees who prescribe, purchase, or recommend the use of drugs or medical equipment. Drug companies and device manufacturers spent about $1.7 million for more than 1,400 trips taken by DOD doctors, medical researchers, pharmacists, and other health care employees over the decade, creating relationships that pose serious conflict of interest issues, according to medical ethics experts. From 2000 to 2006, the DOD prescription drug budget ballooned from $1.6 billion to more than $6 billion a year. “

http://www.publicintegrity.org…..ntry/1409/

One might think the medical services industry would care less about how its members get paid – via public or private insurance – than that its members get paid.

Contra, is the often too-cozy relationship between big pharma and some medical practitioners for funding, trials, patents, drug research, etc. This, too, may be a case of the big guys, as opposed to many practitioners, fighting for what’s good for them rather than their broader membership or those whose pains and ills, births and deaths, pay for their daily bread.

A public option would not be credible if it “sets” prices rather than negotiates them with reasonable commercial standards in mind. Which opens the whole miasma of current pricing. Patients treated for free or who go bankrupt because it’s impossible for them to pay their medical bills are losses covered by charging other patients too much.

Then there’s the farce of insurance companies paying only a percentage of the billed cost because the billed cost supposedly exceeds a purported average cost for such services. How likely is it, given that circumstance, that doctors calculate what they want to recover for a given service and charge cost plus to the patient/insurer, expecting to recover their target price. Not an unreasonable action, given the rapaciousness of insurance companies and their propensity to practice medicine without a license by choosing which services are “covered”, in what order and for what amounts.

The problems are too great, and both parties are too fractured over this issue, to study and revise these excesses all at once. But doing so is essential. The prime mover should be, however, institution of a credible public insurance program. In the 1930’s, the publicly-owned TVA exposed the inconsistencies and rapaciousness of pricing for power generation by making and selling it for a reasonable amount. A public health insurance program could do something similar for health care: establish workable benchmarks. Immediately, with regard to processing and paying for health care – without exceptions, such as “pre-existing injuries”. In the long term, with regard to rationalizing pricing for services and drugs.

That it’s cheaper to fly to Thailand for treatment plus vacation for many procedures suggests pricing here is out of whack. Our vaunted medical care industry may be the best in the world, but only for those who can afford it. With incomes stagnant in real terms since about 1980, that number is getting lower and lower. As someone recently pointed out, the number of uninsured Americans exceeds all of Canada’s population.

Expecting the AMA to get on the change wagon may be like expecting the Chamber of Commerce to lobby for better business regulation. But when their interests are opposed to their patients, they should not have the last or most persuasive word.

The AMA position is also not truly in the interest of the bulk of its membership, althought the ones I know are mostly too self-absorbed to see that.

Doctors are now basically employees rather than independent professionals or small businessmen. They are employees of the insurance companies whose networks they must join and whose payscales and supervision they must accept. They have the same freedom of action I do: they can quit the network, lose the work, and not get paid. They even have to pay for their own health insurance.

I guess we will now see how serious the dems are about reform. They knew this was coming. Are they ready to use this to bail? Or are we going to be represented by our government this time?

Or, how many people have to die from lack of care before something is done?

Even though I am not surprised by the wide stance of the AMA it certainly has energized and angered me.

Good point. It suggests big pharma and big insurers are pressuring the medical profession in order to protect the former’s interests, lest those interests slash their compensation to health care providers.

Private insurers will wage war with the public insurance program “’til death do they part”. The reality of that needs to be built into the public program. Two examples: Prohibit retaliation in any form against doctors or hospitals who accept “publicly insured” patients. Prohibit direct or indirect subsidies by private insurers – bribes – for those doctors or hospitals who accept no or few publicly insured patients.

It’s clear that this will be a national battle for trillions of dollars over many years. The resources allocated to the public plan should be adequate to meet the task and not leave it like PBS, beholden short-term funding from an often unfriendly legislature.

I brought this up in Late Night when I first read it. I was pretty irritated at the time. I have since calmed down a little.

First, the AMA doesn’t represent all doctors on this.

Second, as we have seen with so many institutions, the AMA has come to represent more the interests of its own leadership than those of its members, i.e. the AMA leadership has been bought out by its ties to and benefits from the healthcare industry.

Third, no matter how you slice it, this is a very cowardly position for the AMA to take.

I think our response should be to discredit the AMA which does not serve the interests of its members and has totally blown off the needs of patients.

If they want to act as greedy doctors only out for themselves, then this is how we should depict them, at every opportunity.

We need to compare the AMA to the banksters.
Unfettered capitalism kills.

Some animals are more equal than others; ring a bell?

Let me just check the laws written on the barn wall. They keep changing, at night, when we’re not looking.

Posted this also in another thread but more on topic here:

How do you like this piece of objctivity from CNN Money:

http://money.cnn.com/2009/06/1…..ostpopular

The crucial question about Obama’s agenda has always been whether it really will slow the disastrous rise in health-care spending, or actually increase it while hiding the real costs of the new system. On analyzing the bills, the conclusion is inescapable: Obama promises Americans what appears to be a bargain by heavily subsidizing their premiums. But the only way to pay for what’s really outrageously expensive coverage will be huge tax increases, especially on the same middle class that’s being wooed as the chief beneficiary of reform.

The plans contain four proposals that will substantially weaken the ability of the market, already limited by burdensome regulation, to restrain medical spending.

Yeah, the problem with healthcare, just like with the financial industry, was over-regulation. The drumbeat of stupidity never ends.

CONGRESS COMPLICIT IN HOMOCIDE…period

http://oxdown.firedoglake.com/diary/5722

un effing believable!!!

Take a look at the comments to the NYT article — link at top of post. Lots of physicians/providers writing in to say, “AMA does not speak for me.”

That was the point of my allusion to compensation incentives leading to “system risks”

the AMA represents roughly 20% of 750,000 doctors in this country

from in these times (via national nurses): AMA’s Conflicted President

Dr. Nancy Nielsen’s résumé is exhaustive. Currently a clinical professor of medicine and senior associate dean for medical education at the University of Buffalo School of Medicine and Biomedical Sciences, Nielsen has worked for the New York State Department of Health and has held various leadership positions in the American Medical Association (AMA). So it’s not surprising that the AMA voted her president-elect last June, only the second woman to hold the post. Yet other jobs on Nielsen’s résumé have alarmed some progressive healthcare advocates.

From October 2004 to July 2007, Nielsen served as chief medical officer of Independent Health Association, a Buffalo-based HMO. Although AMA spokesperson Brenda Crane notes that Nielsen ended her affiliation with Independent Health upon receiving her promotion at the AMA, her tenure raises flags for Geri Jenkins, president of the California Nurses Association, a healthcare union.

“I think you have a conflict when you have someone in that position who’s worked for an insurance company and is also a physician who’s going to run the AMA,” Jenkins says.

In a vacuum, Nielsen’s professional relationships might be considered inconsequential. But the AMA has a long history of thwarting progressive healthcare reform, which amplifies the importance of her connection to the insurance industry.

hit em with a chair selise!!!!

Amazing statement from the CNN “Money” guy. The writer had to be unusually obtuse to write this:

But the government will keep a lid on prices, so Americans, for the first time, will be faced with rationing.

. . . as though the current system had not already “rationed” 46 million out of nominal coverage and millions more out of actual coverage through discrimination and denial/delay of claims.

There’s an interesting issue acknowledge, which is that we’re moving towards utility-style cost of service regulations. One of the principles of utility regulation is that you have to cover full revenue requirements, including cost of capital to cover investments needed to sustain the obligation to serve. But the assumption among both advocates and critics is that the Govt would arbitrarily depress prices and reduce payments below that level. That’s not sustainable; it really does lead to shortages. So implicit in the notion of setting rates is that you have to have rates high enough to sustain the level (quantity and quality) of services you want to achieve. It’s a hard task, but the alternative is to let a non-competive market, dominated by a small number of dominant firms, set prices, and every econ textbook tells you that leads to less supply, lower quality and higher prices than a truly competitive model would (in theory).

I’ve seen no discussion of these basic pricing principles in any of the debates. Instead, it’s all gibberish about how competition will magically produce the efficient outcomes. Nope.

Is there a source for that. I’ve been seeing numbers as high as 40%, but I don’t know. There are thousands in the PNHP group advocating single payer, but I guess that’s less than 10%?

i read it on daily Kos,apparently AMA,can use ANY md LIVE OR DEAD ,student or practioner in their number

i’m still very skeptical of the whole public plan in competition with private insurance thing – can it be designed to create the right incentives in ways that are not easily undermined by regulation that insurance lobbyists will be able to influence? will it be robust enough, as social security has been (at least mostly), to weather republican administrations?

imo, if the anti-reform, pro-insurance forces are going to fight all out anything that resembles true reform, i think we should fight for what really want (in my case that would be single payer universal health care along the lines of hr 676) and then compromise as necessary.

edit to add: that has the added benefit of keeping single payer (if that is your preferred policy choice) in the public discussion. this is a marathon, not a sprint and i want to keep the long view.

n a surprise to absolutely no one, the Bartleby-like vampires at the American Medical Association (AMA) would “prefer not to” have any major changes to the current bloated system of medical care in the United States. The New York Times reports that the AMA opposes the creation of a publicly funded health insurance plan. President Obama will address the AMA during their convention in Chicago on Monday.

Of course, the AMA is just a part of what is now one of the largest industries in the United States and the world. The “Health Care Industry” now accounts for 17 percent of American’s Gross Domestic Product. This market share of American dollars is expected to grow to 20 percent of the GDP within the next eight years.

The AMA joined with other health care organizations in sending a letter to President Obama last week offering their concern for health care costs and their willingness to help. They offered to help bring things under control after decades of health care costs rising at more than double the rate of the inflation. They offered to help after creating a health care system in which Americans pay more than $1 trillion more per year than any other country on the planet.

So what did they offer to do? Did they offer to bring American health care costs in line with other industrialized nations? No. Did they offer to make sure proper health care was available and affordable to all American citizens as a basic human right? No. Did they offer to make access to healthcare more important than money? No.

American Medical Association, Obama, New York Times, Heath Care, GDPWhat they offered was to help “in the next decade” achieving the “goal of decreasing by 1.5 percentage points the annual health care spending growth rate – saving $2 trillion or more.” So, even though health care costs are out of control, and have been for a long time, they are now willing to lessen their annual rate of increased greed and avarice by 1.5 percent. To make sure there is no confusion, they are not offering to lower healthcare costs by 1.5 percent annually. They are just offering to lower growth by 1.5 percent. And with the creative accounting that has gotten America into its current economic mess, the health care industry is going to help us “save $2 trillion or more.”

To add insult to injury, the AMA and the others representing the “Health Care Industry” had the gall to preface their offer with the following line, “As restructuring takes hold and the population’s health improves over the coming decade…” Who do they think they are kidding? American health has done nothing but decline for decades.(the Examiner)

Over at the Huffington Post Dr. Chris McCoy (Policy Chair for the National Physicians Alliance) throws down the gauntlet:

Dear AMA: I Quit!

i literally have tears in my eyes.. thanks for the link

LOL!

so long as no one gets hurt *g*

This is from yesterday at Single Payer Action. everybody in..nobody out..Yes, it is the whole page, but I don’t think the group would object as their reason for existence is to fight for single payer. HR 676 appears to be one battle that Conyers will not back down on. His last paragraph sums up the problem you are facing.
****************

John Conyers (D-Michigan) was not happy last night with his colleagues Charles Rangel (D-New York) and Henry Waxman (D-California).

Conyers is sponsor of the single payer bill (HR 676) in the House.

The bill has 79 co-sponsors.

Rangel and Waxman were co-sponsors last year.

But they are not co-sponsors this year.

Rangel, Waxman and George Miller (D-California) each chair committees that will be hearing health care reform proposals.

Only Miller is cooperating with Conyers – remaining a co-sponsor of HR 676 and holding hearings.

In fact, Miller’s committee today held the first ever Congressional hearing on HR 676.

Conyers spoke last night on Capitol Hill at a dinner in honor of outgoing Public Citizen President Joan Claybrook.

“There are three committees that have been designated to work on (health care) on the House side,” Conyers said. “[They are headed by] three dear buddies of mine – Charlie Rangel, Henry Waxman and George Miller. Guess what? All of them were on single payer (HR 676).”

“Guess what? All of them got off except for George Miller of California. Not only did he not get off, he said — you want a hearing, you got a hearing.”

“It’s one thing to go down in defeat, which I don’t plan to do by the way,” Conyers said. “But it’s another thing to say – we don’t want to hear the most popular bill. I’ve got 79 co-sponsors. Seventy-nine men and women saying – let’s get this thing on. We’ve got 300 to 400 unions. We’ve had three polls. The American people have spoken.”

“And here I am in the most Democratically controlled legislature in my life. And they are saying – it’s kind of too late because we have to get this thing through by the end of July. And we don’t have time.”

“Hey look – I’ve worked on this too damn long to let anybody – I’m going to every Committee not just Miller’s. Charlie Rangel – get ready for your pal to come to your Committee.”

“Henry Waxman, my brilliant friend, open up your door. And then if you want to try to pull something that’s okay. But to tell me it’s too late – I’ve got news for you. That means you really didn’t know me all of these years.”

“We’re going to have HR 676 heard in every committee of the House of Representatives or my name ain’t John Conyers.”

“I don’t mind losing a debate or losing the vote, but Jesus Christ don’t tell me that my proposal is off the table before we start, without even a hearing,” Conyers said.

“What kind of a Democratic congress is this?” he asked.

Conyers also gave the back of his hand to President Obama.

“I’ve finally persuaded my favorite president in life to – not put single payer on the table – but to at least let me in the room,” Conyers said. “That was a great complement I suppose.”

“How are you going to have a transformational health care program that has been vaunted and touted for so long if you take the most popular remedy for it off the table to begin the negotiations?” Conyers asked. “You won’t get it.”

“The reason is elementary Dear Watson,” Conyers said. “The corporate health care people, the insurance people don’t want to leave the room. And they are not leaving the room. And as long as they are there, you are going to have some sad version of the same crap you were supposed to be fixing in the first place.”

(Listen to audio of Conyers’ remarks here.)

http://www.singlepayeraction.org/blog/?p=919

Thanks. I’ll that update.

hahahaahahahaha
WAS JUST GONNA POST THAT
hey NYers CALIFs

call Rangel and Waxman…threaten if necessary…primary challenge

http://www.visi.com/juan/congress/index.html

AMA walks back on its statement; could support some form of public plan.

http://blog.healthcareforameri…..hemselves/

AMA folds, sortof:

“Today’s New York Times story creates a false impression about the AMA’s position on a public plan option in health care reform legislation. The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, but the AMA is willing to consider other variations of the public plan that are currently under discussion in Congress. This includes a federally chartered co-op health plan or a level playing field option for all plans. The AMA is working to achieve meaningful health reform this year and is ready to stand behind legislation that includes coverage options that work for patients and physicians.”

This “co-op health plan” is going to keep coming up again and again. NH Senator and Republican Judd Gregg propped this piece of crap idea up recently. New Hampshire is 93% white. Has a 64 grand median income compared to 50 grand in all of the USA. Gregg’s state’s uninsured population is 10.5% whereas, Texas is 24%, New Mexico is 22%, and Florida is 20%. Gregg has no constituency with a need for single-payer options. So, if there is going to be a grassroots movement for single-payer options please get the data together on which states stand to gain the most from it. Get organized.

You know, I’m in the rest of the world, and I can tell you, we don’t think of America as having the Best Health Care System in the World. We think of you as being the place that ambulance drivers ask for your credit card before taking you to hospital.

Great minds think alike?..’g’

Dear Scarecrow,
We hope for a miracle – that Single-Payer emerges, and teh Goopers and DoofiiDems are helpless to stop it.

But one wonders – what will you do with yourself if it happens?
Dude, you’re on fire! Thank you for being just all over this.

Thank you, Scarecrow, for your constant unrelenting spotlight on this.

We need to do everything we can to make this happen, and happen right.

An excellent article by Dr.Roy Poses indicates how the AMA operates in the shadow and has long worked to “empower” or reward specialist while promoting policies (suggested payment schedules) that encourage our supply of general practitioners to dwindle. It appears that those who are not part of the solution (as the AMA obviously is NOT) are part of the problem.

http://hcrenewal.blogspot.com/…..html#links

What will I do if we “win”? Easy.

I will get that brain I’ve always wanted.

Dibs on the left-overs!

in addition to single payer universal healthcare we could use a rational energy policy so that we 1) save the planet and 2) decouple the economy from oil prices and the perceived need to control oil.

This will be interesting. There is a whole industry consisting of
1) professional associations (including AMA),
2) private insurance companies and providers,
3) medicare rate setting agencies (heavily influenced by 1) above,
4) medical care research business (especially the part of it funded by industry)

that produced the price structure for medical care that we see in the U.S. today.

As one very distinguished doctor told me (from memory, and with snark removed): The AMA and these professional associations run the advisory boards, and companies pay for these research studies, to get the fees they want for the stuff they want. So, you end up making money by ordering tests and doing procedures, not by spending time with patients.

I think there will be even more turmoil within the AMA that has been seen in awhile. The doctors who make most of their money by ording tests and doing procedures, the doctors who prescribe for different types of conditions, and those who practice primary and preventive medcine, splitting into camps with different persepctives.

Whe we say we have cadillac medicine in the U.S., that is not really true. We have cadillac-rolls-royce high tech medicine. But we have very over priced, broken down, and stingy (not sure what car to insult here…) primary care and preventive medicine.

It is actually much more expensive, and harder, with longer waits here in the U.S. just to go in and get basic primary and family care, than in most European countries with their gummint run socialized medicine.

The think people are overlooking is that this is not just a result of the private insurance companies. It is a result of a whole private and public medical research and fee setting industry that is beginning to fear that their world will be upset.

The kind of care that Mayo Clinic represents (which was mentioned in the NYorker article) is often infeasible because of price structure for reimbursement, and quarterly profit driven competition for getting on a companies open enrollment list, etc. There are other places that do May style care, but there are many places where it is just not feasible, no matter how the doctors would like to practice their trade.

The reimbursement structure, rules and regulatons have a lot to do with this.

A 2007 AP article at http://www.associatedcontent.c….._care.html tells about a young boy who–as the conservatives would have us believe–HAD access to healthcare (the local emergency room). Emergency room treatment is not a substitute for accessible, affordable healthcare. Why can’t conservatives “do the numbers”? The amount spent to save this child’s life (and SOMEONE had to pick up the bill) could have provided years of accessible treatment not only for young D. Driver but many others. DO THE MATH, conservatives!

And ironically, from my point of view, medicare plays a big role in the way the current reimbursement structure is set, even in the private sector.

Because Medicare is so big, and because it has a publicly reviewed process for decision making, it has become the big dawg in terms of much of the nuts and bolts of how medical care services are reimbursed. Private industry tends to organize itself around what Medicare has decided to do -even though, as far as I know, there is no requirement at all that it do this.

The first thing everyone thinks about when a new procedure, drug or approach is found to be useful, is “how will we get paid for this?” One has to be at the table with money to get the studies done, get the nod of approval from medical advisory boards, Medicare, and private insurers.

It is kind of like the military industrial complex, but it’s very seldom discussed in public debates. I think that how this system works will have to be tackled to reduce health care costs.

Unlike Krugman, I do not believe that reducing private insurance waste will do it. Certain kinds of doctors, drugs, many procedures, cost far more here than in other countries. That is why one well-known health care economist said that the high price of medical care in the U.S. was not really a cost, it was a kind of private taxation system that transferred national income to doctors, insurers, and private providers.

a little off topic but under the ama umbrella;

they complain all the time about premiums and the costs that are deferred onto patients

I have a simple solution;

why doesn’t the ama provide internal liability insurance for their members?

that will addresss a host of issues, for instance it will then be as efficient as possible with very little adminsitrative overhead and the rates will reflect actual liability rather then profit

it will also force them to police their own poor perperformers, get them off internal insurance and force them to go outside the box

this seems to me a no brainer yet I am the only person I ever heard talk about it

BlueGirl’s diary promoted!
Healthcare Reform is Coming, Whether the AMA Likes It or Not

It’s a bit like asking Wall Street to self-regulate. Left to its own devices, you’ll have the chairman of the stock exchange collecting a hundred million dollar retirement package, no credible regulation or enforcement, and a “shit happens” grin when markets, industries and financial houses tumble down.

Same with the health insurance industry, which is more like an Al Capone protection racket. Selling protection or beer or women – or health insurance that sounds good but costs a packet and rarely pays for what you most need – is meeting a legitimate societal need. All he or it ask for is a reasonable profit and that you do things the Chicago way. Time for a health care Eliot Ness.

Health insurers seem long ago to have left behind their role as administrators of the payments for health care decided upon by health care professionals. They converted the power to pay into the power to determine whether treatment was necessary – the definition of the practice of medicine. They rigged the system. These bookies don’t just decide whose bets they’ll accept; they choose whether to pay off winning bets at all.

Jane has very interesting news, upstairs!
Obama Writes Letter Opposing Inclusion of Graham-Lieberman in Supplemental

people are workin’ on it

If doctors want 100% of their fee
and they have to charge insurance companies 200%
to get their 100% of fee,
then they’re just playing games and though it’s a nuisance it’s doable.

But, if the insurance company comes to indivduals and says *look* *at* this
then what’s an individual to do but pay a higher premium,
so the insurance company ends up with more revenues and more profits.

Thus, cutting the crap game and requiring insurance companies to pay
what the doctors charge without any insurance company doctor denying services should reduce prices significantly for everyone without any major systemic reform.

It’s like some of Wall Street’s gimmicky crap which gives them billions. Cut through that crap and the thieves lose their edge.

could it be that medicare is not that great of an idea?

But don’t insurance companies have an interest in charging as little as possible?

Stockholders and corporate boards love to keep the profits low, and the service high.

Anyway, welcome, as I have not made your acquaintance.