My Response to the AMA

The AMA, after previously stating that they were not in favor of any health care reform plan that included a public option, has recently and surprisingly done a 180 degree reverse course and effectively endorsed the House of Representatives (Democrat) health care reform bill, H.R. 3200, "America's Affordable Health Choices Act of 2009". I am flabbergasted; I am sick; I am angry; I am more postal than I have ever been before. Good thing I don't own a gun.

I have expressed my displeasure in an email to James Rohack, M.D., the current president of the AMA. Following is the text of that letter:


I am completely aghast at the AMA’s endorsement of H.R. 3200, “America's (so-called) Affordable Health Choices Act of 2009". I cannot believe that the leaders of the AMA could have been led so astray by this misbegotten piece of legislation that they could endorse a plan that is tantamount to the premeditated murder of the greatest medical care system in the world.

I am not opposed to the concept of reform of what we call our ‘healthcare’ system, even though it is not now and never has been a healthcare system -- we have a medical care system, the best in the world, and this is significantly different from a system to promote health, a distinction that is crucially important but is being completely ignored. However, increasing government control of the medical care system (which H.R. 3200 does) will make matters worse rather than better. This is reform only if you consider tightening the garrote around one’s neck to be reform. Even cursory examination of the bill reveals that it calls for the creation of at least 31 new federal programs, agencies, and commissions (and the necessary bureaucracies to support each one) all to increase the regulation of medical care. These new programs and agencies include such horrors as a new Health Choice Administration (sitting alongside the Centers for Medicare and Medicaid Services and the Department of Health and Human Services) and a new National Health Care Workforce Commission, whose task will be to decide when and where medical care workforces can and will be altered (and likely decreased as the need for rationing becomes ever more necessary under this plan). Complying with the new regulations to be promulgated by all these bureaucracies will increase both the cost and the hassle of operating a medical practice at a time when practice revenues will be going down. And yes, I said down.

In an editorial posted on the Heritage Foundation website, John O’Shea M.D. discusses testimony presented before the House Energy and Commerce Committee by The Lewin Group. In this testimony, they estimated that “if the public plan is open to individuals and all employers using Medicare payment levels plus 5 percent, as planned, physician net income would fall by 5.4 percent. The loss of net-income would average about $16,207 per physician.” Furthermore, this decrease is probably underestimated, since The Lewin Group predicts that 113.5 million people would be shifted by their employers from private insurance to the public plan, with the concurrent decrease in revenue that would subsequently entail. With the fines to employers set at no more than 8% of payroll if employers do not provide insurance (and even lower for small businesses with smaller payrolls), I feel that the estimate of only 113.5 million people being moved to the public option is decidedly too low. H.R. 3200 will therefore serve as the back door into a de facto government-controlled, single-payer system to which AMA policy is supposedly opposed.

H.R. 3200 does not provide for any improvement in the runaway costs of the medical care system. The Congressional Budget Office’s initial estimate of the cost of this program is set at over $1 trillion dollars over the first ten years. The CBO also specifically notes, “It is important to note that the figures presented here do not represent a complete cost estimate for the coverage provisions of the legislation. They reflect specifications provided by the committee staff rather than detailed analysis of the legislative language.” In other words, it is based on an analysis of only part of the proposed legislation; if all of it were analyzed, the costs would likely be higher. This will add at least $219 billion more to the federal deficit at a time when it is already at unprecedented highs. The CBO also states in their analysis that nothing in H.R. 3200 will reduce the rate of growth of medical costs, despite that being its sole reason for being proposed.

The CBO estimate also covers only the first ten years, with most of the expenditures in the second half of that ten year period. The cost of the second ten years (and so on) is not addressed. Recall that the first-ten-year estimates for Medicare Part D were only $400 billion, but the estimates for the second ten years are at least $1 trillion for Medicare Part D alone. Also remember that the AMA opposed the creation of Medicare and Medicaid in the first place, back in the 1960’s, with one of the objections being that the cost estimates were woefully low. The AMA was correct then: in its first year Medicare cost $64 million, while it has now ballooned to a $500 billion/yr program, while Medicaid has expanded from $770 million in its first year to $264 billion/yr today. Government predictions of the cost of programs are always inaccurate to the low side. If the rate of growth of the cost of H.R. 3200 is the 6% stated by the CBO, then within 25 years this program will be costing the USA as much more again as Medicare costs now. The CBO is right -- it is unsustainable.

This does not even consider the fact that the Virginia-based Council for Affordable Health Insurance has estimated that the administrative expenses of both Medicare and Medicaid over the last decade were 66% higher than those of private sector health insurance companies. There is no reason to suspect that the administrative expenses of H.R. 3200 will be any less and every reason to expect that they will be greater.

True reform is not the expansion of governmental regulation and control of the medical care system. True reform is the reduction if not elimination of unnecessary governmental regulation and control of the medical care system. True reform is a return to a situation in which patient care is delivered and decided upon by a patient and his or here physician without the intrusion of the government or an insurance company. True reform is a system in which the financial aspects of medical care are also between the patient and the physician, with the insurance company only dealing financially with the patient. True reform is a system in which insurance is permanently and irrevocably detached from employment, with the tax incentives for buying insurance granted to the individual, and the employer giving the employee the funds to pay for that insurance through higher wages. True reform allows the power of the free market, which has been kept in chains for the last 70 or more years by ever-increasing governmental regulations, to be turned loose and increase efficiency and quality. True reform requires the government to step in only to eliminate predatory practices and to help out those few individuals who truly cannot provide for themselves. (And this last only because the USA is a Christian and charitable society, and not because there is some bogus universal “right” to medical care.)

H.R. 3200 does none of these things. It in fact does the exact opposite of every one of them.

Since I entered medical school 24 years ago, I have been a member of the AMA. I joined because I thought it was important for physicians to have an organization to speak for them collectively, to fight for what we need and what our patients need -- to fight against primarily the government as I recognized even then that it was the government from which we physicians have the most to fear. Repeatedly I have been let down by the AMA as I watched the organization walk away from contest after contest with the government, not bloodied and beaten, but whimpering and skulking away without even engaging in the battle. For ten years or more I have waited for the AMA to bring the issue of the SGR to a crisis point by walking away from the negotiating table and saying ‘call us back when you’re willing to talk seriously -- and by the way, we’ll enjoy watching you try to provide medical care without any physicians’, only to be disappointed year after year with temporary fixes which provided little relief from the increasing inflation affecting the cost of running a practice and no resolution to the problem with the SGR. We have always had the power to fix the SGR, but you -- the AMA -- refused to use it. And now to get a fix for the SGR, the AMA is swallowing a poisoned pill that will kill everything that is great about the American medical care system. It was my belief that the AMA was supposed to stand behind me. I didn't expect it was so they could stab me in the back with a dagger, not just once, but dozens or hundreds of times.

I insist that the AMA reverse this decision on supporting H.R. 3200 and that the AMA go on the offensive opposing this abomination before it is too late -- too late for the medical profession, too late for our patients, and too late for the greatest medical care system ever created by mankind.

If the AMA will not change course on this issue, I will have no other recourse but to cancel my membership and demand that all money that I have ever donated to AMPAC be returned to me. I do not wish for any of the funding that has led to this looming catastrophe to have come from me. And I will urgently encourage all of my colleagues to do the same.