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Yesterday the American Medical Association (AMA) announced that it would not be in favor of any kind of government sponsored health insurance for people under age 65. They said that that would not help keep costs down or expand coverage. Only a cretin would conclude that government sponsored plans with 2% administrative costs would be more expensive that bloated private plans with 32% overhead. That is why the private insurance guys are so scared. This dinosaur organization, which incidentally fought tooth and nail against Medicare, is largely responsible for the pathetic state that American healthcare is in today. The AMA is nothing more than a representation of everything that is wrong with American physicians, i.e. greed, gluttony and self interest, in case you haven’t read the papers lately. While Nancy Nielsen MD of the AMA pigs out with the likes of Janet Ignani of the American Health Insurance Plans (AHIP), thousands of people dying because of no access to medical care.
Mmmm. Supper time for medical Gang of Four: (from L) Max Baucus (D-Mont), Karen Ignagni (AHIP), Rich Umbdenstock (AHA), Billy Tauzin (PhRMA), Nancy Nielsen MD (AMA).
The New York Times today pointed out today that the AMA does not speak for all doctors. Ahem. At this point any doctor that would be associated with that foul organization should hang their head in shame.
An article in this month’s New Yorker called The Cost Conundrum by Atul Gawande MD has gotten the attention of the current administration in Washington. The news that McAllen TX had the most expensive healthcare in the country as measured by Medicare expenditure per capita, twice as much as Rochester MN, site of the Mayo Clinic, with three thousand more spent per person than the average per capita income in the county, caused President Barack Obama to say “we’ve got to fix this.”
What was more interesting to me was the fact that none of the hospital administrators had any idea that their spending was so far out of control. The fact is for years researchers at Dartmouth and elsewhere have been documenting the gross aberrations in healthcare spending on a regional basis. And does it translate into better healthcare outcomes? Nope. States like Florida and Texas with the highest spending are in the bottom 25% on health outcomes. And you can’t blame it all on lifestyle. Smoking and alcohol use is lower in the US than in most European countries, and we have worse healthcare outcomes and spend more on healthcare. 37% of Americans skip medical care or don’t take prescribed medications because of an inability to afford it, and the US has the highest rate of medical error of any industrialized country, with 32% of patients with chronic conditions reporting that they had been subjected to medical error. And the frequent comparisons made to the Canadian healthcare system are a bunch of nonsense.
The problem, as pointed out in the article, is that there is no disincentive to avoid costly medical tests. And the doctors can’t blame it on fear of lawsuits because Texas now has a cap on damages that has caused those to dry up. The fact is, that physicians are now becoming partners in imaging facilities and hospitals, so they have a conflict of interest.
When I was in training in our Nuclear Cardiology seminars at Yale, I would joke that the conclusion of every case was that the patient should receive a cardiac catheterization (where they pass a wire into your arteries and shoot die and take a picture)– so why bother talking about it? It’s gotten even worse now. If you have chest pain in McAllen, you will probably get a cardiac catheterization. For what? Cardiac surgery results in real benefit for only 3% of patients, and that is for those who actually have heart disease. Stomach pain? Take out your gall bladder. The problem of skyrocketing costs is related to use of medical testing and procedures that is not beneficial to patients. I for one would not let a surgeon bully me into an unnecessary surgery that could possibly result in cognitive complications from the anesthesia.
Update: read Alison Bass blog “More doctors disagreeing with AMA on universal healthcare.”
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Thanks for your post. If I were a medical doctor, I would be outraged. The AMA is the largest organization of physicians in the US. People who are not physicians tend to see the AMA as an institution reflecting what most physicians believe. My fear now is that the American people will begin to see universal health care options as bad because it is what their physicians are rejecting. Physicians in the US really need to work on making it clear to Americans that the AMA is not the only or majority voice of AMA physicians. It would be great if more physicians would drop out of the AMA as a result of this position.
Thanks for the useful info. It’s so interesting
if only more docs were like you…I bet the docs in my family are card carrying AMA docs!! Good for you Doug…
The AMA does not represent doctors. But they are correct about opposing a govt run plan. The present administration wants as much conttrol over the private sector healthcare system as possible to “spread the wealth”. I am sorry but this will only bring down the system. If you believe it is fair to take from those who have and give to those that do not, then you want a govt system.
If instead you believe that those who have should be incentivized to help bring up those who do not have, then you should oppose the govt plan.
Our president’s views have not changed, he is just incrementally moving towards his European vision for our country. As for our healthcare system, that is a grand shame!!
Well a lot of the costs are for hospital and insurance plan CEOs raking in hundreds of thousands of dollars so they can ape being ‘real’ CEOs when in fact healthcare never has run as a true capitalistic enterprise. We have all seen it up close and personal and know that if those clowns were in a real capitalistic enterprise they would blow away in a few weeks.
Doug:
The insurance companies have a racket, that is a given.
So the answer is to give it over to the government??? Ever heard you can’t fight city hall???
Change the rules to make healthcare more competitive in a free market environment WITHOUT the govt price-fixing and using political bureaucrats to screw things up even further.
Going postal in 2009, will be changed to going medical in 2010 if OBama gets his way. Quality of care will go down, down , down !!!!
I don’t think that healthcare operates on a capitalistic system, and I don’t think it every has. In the old days it was just charge the blues and they pay up. There was no competition.
Doug:
OK, How bout charge the individual, and getthe Blues out of it!
Use the Blues for patient reimbursement only.
Have the patient’s get some skin in the game.
If the govt wants to help, hire docs and nurses for govt state clinics. Let the govt payback some of the astronomical student loan debt docs have in repayment for treating those who can not afford to pay.
With the third parties out of the system, a true free market for individuals exists, competition develops, prices go down and quality goes up.
Email me directly to see how my practice works with this very style of practice.
I admire very much your research on meds and big pharma studies. You provide excellent insight. But on payieng for healthcare, I believe you are on the wrong track!
I think we should operate our health care just like Canada does.
Angioplasty:
Why don’t you move to Canada and become a citizen there. Then you can have that system. And when you are older, and need care that Canade will not give you, come back to the USA and obtain it. If we keep a semblance of a free market system, it will still be available. If the govt takes it over, forget about it!!!!