American Money Association

[McCamy Taylor]

Intro.

I am writing this, because an organization which claims to represent me (though I am not a member) has made a statement opposing the only sane solution to our current health care crisis. As other DUers have noted, the AMA does not represent all doctors. For instance, there is a group called "Physicians for a National Health Care Program" which advocates a single payer plan on the front of its web page.

http://www.pnhp.org/

Our health care system is broken. From the PNHP link above

The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 45.7 million without health coverage and millions more inadequately covered.

Just how poorly does our deluxe health care system perform? A glance at this chart

http://www.infoplease.com/world/statistics/infant-mortality-life-expectancy.html

Shows that our infant mortality rate rivals that of…

Cyprus? Poland? Our life expectancy compares favorably to Albania. So much for the best health care system in the world. About the only area in which the United States leads the world is physicians’ salaries. We pay our specialists more than twice as much as they do in other industrialized countries. Salaries are high, because American doctors perform more procedures and see more patients. Which begs the question, with all these hot shot surgeons working overtime, why are our clinical outcomes so poor?

http://www.healthbeatblog.org/2008/01/health-care-s-1.html

More than two decades of research done by doctors at Dartmouth show that outcomes are no better in parts of the country where patients see more specialists and spend more time in hospital beds. In fact often these outcomes (which are adjusted for differences in race, sex and overall health of the population in different regions) are better when patients receive less intensive, less aggressive and less expensive care.

Maybe we have the current overpriced under performing health care system---which leaves 50 million of us without access to care---because a certain organization, the AMA has played such a big role in determining our nation's health care policies for over one hundred years. Though it is called the American Medical Association, a better name might be the American Physicians Association. Or maybe, the American Money Association.


I. Money

In 2008, the AMA debated two issues. One was the concept of the “medical home”, in which people have a primary care physician who coordinates their care with an emphasis on the whole person as opposed to an isolated organ system. The specialists raised an objection.

Peter Schwartz, M.D., also an ob-gyn, added that "Medicare Part B is not expanding any time soon" and that funds diverted to primary care would inevitably mean less money for specialty care. He urged that the concept not be adopted until the Council on Medical Services came back with its report in June.

http://pn.psychiatryonline.org/cgi/content/full/43/24/4

Cutting back on the money we pay to treat disease so that we can prevent disease instead? Why, that is as good a description of godless communism as I have ever heard. If Jesus wanted us to have healthy coronary arteries, he would not put a McDonalds on every corner or pay subsidies to tobacco farmers.


A second hotly debated topic was the issue of comparing alternative treatments for medical problems. Such research is useful in proving which therapies are most effective. In addition, if several treatments are found to be equally effective, an analysis of the cost-benefit can help direct health policy.

But as with the medical-home resolution, the report on CER raised some concern about how such an entity would affect physician payment for various treatments, particularly if the body doing the research incorporates cost-effectiveness research.

"The way the council felt about this is that the CER body shouldn't be making coverage or payment decisions, but we did think there has to be some recommendation that items that are of very, very high cost be looked at first," McIntyre explained. "So the exact role of cost-effectiveness wasn't refined at this point."

McIntyre noted, however, that the house did defeat an amendment that would have made cost-effectiveness off limits as a subject for the proposed new CER entity.

An amendment that would have made cost-effectiveness off limits as a subject for the proposed new CER entity? Are these folks for real? Shouldn't they be ashamed to put stuff like that in print where everyone can read it? Imagine that your auto dealer said something like "We are not going to tell you the mileage, because it might influence your decision whether or not to buy our car." Or "You will just have to trust us when we say that our airbags perform as well as_____s." Would you stick around to buy that dealer's vehicle?


II. History Part I: The AMA vs. Everybody

If you review the history of the AMA, you might come away with the impression that they exist to keep the competition in check. For years, they denounced the practice of osteopathic medicine.

Throughout the first half of the twentieth century, the policy of the American Medical Association labeled osteopathic medicine as a cult and osteopaths were seen as "cultist." The AMA code of ethics declared it unethical for a medical physician to voluntarily associate with an osteopath.

http://en.wikipedia.org/wiki/Osteopathic_medicine_in_the_United_States

The AMA has been a thorn in the side of chiropractors:

Medicines opposition to chiropractic was at its strongest under the leadership of Morris Fishbein. Fishbein as Secretary of the American Medical Association from 1924 to 1949, lead a 50 year anti-chiropractic campaign in both professional publications and the public media. Fishbein called chiropractors "rabid dogs" and referred to them as "playful and cute..but killers." He tried to portray chiropractors as members of an unscientific cult, caring about noting but taking their patients money.

http://www.svpvril.com/amavchir.html

Here is the organization’s response to attempts by states to use nurse practitioners in order to relieve the current (primary care) physician shortage.

Advanced-practice nurses -- a group that includes nurse practitioners, nurse anesthetists and nurse midwives -- say they are working within their training and are filling a void that is being left by a growing physician shortage.
Physicians, however, worry patient safety will be compromised.

APNs working outside a physician-led team raise concerns, said AMA Board of Trustees Secretary William A. Hazel Jr., MD. If nonphysicians do not have the proper education for the scope they seek, physicians need to act. He said, "we have to do the right thing by patients."

http://www.ama-assn.org/amednews/2008/04/21/prl20421.htm

Um….so no medical care is better than some medical care? That is a bit counter intuitive. But maybe the AMA just wants to be sure that the people providing health care services are the absolute best at what they do. That must be why they advocate the practice of physician dispensing medication in which doctors take over the role of pharmacists.

The American Medical Association (AMA) endorses the concept of physician dispensing, provided the physicians follow state and federal guidelines, and still allow their patients a choice of where to get their medications.

The overall goal of X-rays, lab tests, surgery and physician dispensing is improved patient health. Physician dispensing is clearly a necessary tool for better patient health.

http://www.americanchronicle.com/articles/view/51624

“Necessary for better patient health”? Only if “better patient health” is code for better financial health of the doctor’s practice. Note that physician dispensing is being sold as a money maker.

Too much work and not enough pay. The same survey showed while 83.1 percent of primary care physicians considered their practices to be very busy or even too busy, 58.6 percent of those surveyed were disappointed in their income. Many struggled with the cost of overhead, and 22 percent worried they could not sustain that overhead in the next five years.

How can primary care physicians generate more income and manage overhead more efficiently without shortchanging the patients who rely on them? The solution is physician medication dispensing.

Solution? If the problem is cheap generic medication, then I guess physician dispensing is the cure, since this system will encourage doctors to write scripts for the newest, most costly drugs.

III. History Part 2: The AMA vs. the American People

The AMA has been fighting universal health insurance almost as long as it has been in existence. Here you can read about how doctors in the U.S. under the umbrella of the AMA turned against compulsory health insurance in the later 1910s.

http://books.google.com/books?id=VHC2nIqWl48C&pg=PA203&lpg=PA203&dq=AMA+1918+compulsory+health+insurance&source=bl&ots=c6Cnb-kpxC&sig=nb9_n9U6EVAgDflpHkm7_zw1cZI&hl=en&ei=RpoxSsOtIYycMpiE8M8H&sa=X&oi=book_result&ct=result&resnum=1#PPP1,M1

In the late 1940s, when Truman tried to create a voluntary national health insurance program, the AMA struck back.

The American Medical Association (AMA) launched a spirited attack against the bill, capitalizing on fears of Communism in the public mind. The AMA characterized the bill as "socalized medicine", and in a forerunner to the rhetoric of the McCarthy era, called Truman White House staffers "followers of the Moscow party line".

http://www.trumanlibrary.org/anniversaries/healthprogram.htm

In the early 1960s, the AMA gave birth to the political career of Ronald Reagan when it hired the actor to lobby against Medicare, which provided national health insurance for only the elderly and disabled.

http://www.larrydewitt.net/Essays/Reagan.htm

By 2007, the AMA has changed its attitude about public financing of health insurance----for kids anyway.

"The American Medical Association is deeply disappointed in the president's veto of bipartisan legislation to protect the health of America's low-income children. The program is vital to protect low-income children whose parents work hard, but aren't able to afford health insurance.

"For children to get a good start in life, they need access to the medical care that this program makes possible. CHIP is an excellent example of a public-private partnership with a full 77 percent of kids in the program getting their coverage through private health plans.

"The number of uninsured kids has increased by nearly one million over the past year, and action must be taken to reverse this trend. The AMA strongly urges members of Congress from both political parties to stand on the side of America's parents and children by voting to override the veto. The nation's children, parents, and physicians are counting on Congress to strengthen this successful program."

Unfortunately, it now appears that the decision in 2007 did not represent a trend. It is hard for anyone, even the AMA to deny health care to kids. Adults are another matter. Today, the New York Times reported that the group opposes the national payer option.

“Health care reform is as important to us as it is to him,” Dr. Nielsen said. “We will be engaged in discussions in a constructive way. But we absolutely oppose government control of health care decisions or mandatory physician participation in any insurance plan.”

http://www.nytimes.com/2009/06/11/us/politics/11health.html

The AMA opposes government control of health care? That can not be right. They send a lot of money each year

http://www.opensecrets.org/orgs/summary.php?id=D000000068

lobbying the government to give doctors a monopoly to treat disease, prescribe drugs, deliver babies etc. What are those laws if not government control of health care? The AMA has also lobbied for food and drug safety (which is regulated by the feds). They do not cry foul when the government sanitizes our water or monitors our air. They want Washington to fight global warming. They abide by immunizations schedules which are written into law---

And yet, an attempt to improve the nation’s health by making care accessible for all is “government control”. I guess it is. I am sort of glad that the federal government wants to take control of the preventable, chronic diseases which cost us so much money and kill us years before our time. I do not think that makes me a medical maverick. Most doctors I know agree with me.

The AMA may have finally dropped off the deep end with this one. Too bad I am not a member. If I was, I could cancel.

[slipslidingaway]

1. knr...and thanks, have not read it all, but your post could get lost

:)

[mojowork_n]

2. Quite a few of the doctors I know...

...are "libertarians."

Sad but true. The smart kids in school who got good grades and just wanted to a way to turn classroom achievement into cash -- through the smoothest, straightest, most direct path available.

I can't say it's the worst thing in the world -- would you want someone from the lower half of the G.P.A. pool operating on you? -- but there should be a way to put that into context, somehow. Get a Bigger Picture on what that particular debate's all about. I came across an article recently that put that whole "libertarian" movement into historical perspective:

http://www.scoop.co.nz/stories/HL0812/S00378.htm

So many doctors are soooo conditioned to have such HIGH expectations for their own outcomes. It's the Achilles Heel of the system.

[Amonester]

3. Kick & Rec. n/t

:kick:

[mojowork_n]

4. Oops, forgot to K & R

Good post, thanks again.

[Amonester]

5. Dr. Taylor, Dr. McCoy (and many other Dr's) is with you.

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x5827419

(#1 Greatest post on the home page). :thumbsup:

Double Kick!

[WillYourVoteBCounted]

6. excellent OP title

grabs you right out of the gate.

[Indenturedebtor]

7. The vast majority of our healthcare costs come from insurance companies

They take over 30% of the total cost of care.

Fix that, then go after docs who work like animals for 20 odd years before they can even really practice on their own.

And chiropracters think that they can solve cancer by cracking your bones... uh yeah.

No I'm not a doc. I work in healthcare IT trying to make care more affordable... so it's something I've looked into a bit.

[wolfgangmo]

11. I agree with you about everything except the chiro crack

Pun intended.

We work and refer with lot's of chiro's at our clinic (primary care) and not one of them has EVER said anything about curing cancer with adjustments. Lot's of them do refer to our clinic for cancer tho.'

Lose to unnecessary cracks at a profession that is, in the whole, ethical and focus on the real problem, the insurance and pharma corps.

Cheers.

[Indenturedebtor]

12. Right you are, and though they may be good at treating many back ailments

Some of the claims I've read about chiro are pretty damn scary. The whole theory behind it strikes me as mega-whompass.

"If you are examined by a chiropractor, you may be told that you have one or more subluxations of your spine. This article examines what this means and how you should react.

Chiropractic theory is rooted in the notions of Daniel David Palmer, a grocer and "magnetic healer" who postulated that the basic cause of disease was interference with the body's nerve supply. Approximately a hundred years ago, he concluded that "A subluxated vertebrae . . . is the cause of 95 percent of all diseases. . . . The other five percent is caused by displaced joints other than those of the vertebral column." <1> He proclaimed that subluxations interfered with the body's expression of "Innate Intelligence"—the "Soul, Spirit, or Spark of Life" that controlled the healing process. He proposed to remedy the gamut of disease by manipulating or "adjusting" the problem areas..."

http://www.quackwatch.com/01QuackeryRelatedTopics/chirosub.html

Yikes...

[Technowitch]

8. In India...

I spent the last three years in India, studying spirituality at a small ashram in a rural part of the country. They usually have some on-staff folks around, but given my spouse and I were there long-term we eventually got to know the main doctor for the village.

He was a really great fellow, and worked with his wife who was an Ayurvedic specialist. We called him 'Doctor Guru' (his actual name was rather longer).

Whenever I got sick, I could call him. Him, not his office staff -- him. On his cell phone. Later that day or early the next, he would come to my apartment to see me. He'd spend so much time, we'd invariably end up offering chai or something. If any medicines were needed, he would go get them.

Want to know how much these house-calls cost me? 150 rupees. About $3 US. Medicines usually cost about as much, perhaps less. In that part of India, my doctor was considered a very well-off man.

While I was in India, I never worried about getting sick or having an accident. Sure, it'd would've been better to have had insurance, but there the costs were so low we really didn't need it.

Now back in America, I know full well that we are one major illness, one accident, away from total bankruptcy. I've had some allergy issues upon returning. Over there, I'd have given my good friend Doctor Guru a call to see if he or his Ayurvedic-specializing wife had some ideas. Here? I self-medicate using OTC at the drug store, and a single packet of Claritin costs more than a doctor's housecall in India.

The number one thing holding back healthcare reform in America is 95% of the citizens have no idea how much better it is elsewhere. That makes them prone to sheep-like herding. "Ohhhh nooooo, you don't want SOCIALIZED medicine do ya? You don't want government takeover of healthcare?!"

Um, if it reprsents an alternative universe where, if I get sick or injured, I just go to my doctor and don't have to think, "Is this the one that wipes us out?" -- frack yeah, sign me up for that!

[truedelphi]

9. Thank you for sharing your story.

I have experienced the working of the health care system in Canada and in Norway - vastly superior to ours even in terms of how they handle situations and in terms of equipment and devices that we don't have until years after they have them.

Allergies - try visiting a health food sotre and buying nettles in bulk. Make a tea from it and sip a mug or two for several days. The taste is awful - but after two days or so, your allergies should be gone for at least a month. Cost of treatment is about $ 1.00

Nettles also will dissolve moles and skin birth marks. And help your hair from going grey.

[dotymed]

10. THANK GOD

My Primary Care Physician is of the same mindset as you. He
has spoken to me often, of the need for Universal Health care.
He cares!
My cardiologist has never discussed it with me, but he has
never asked me about money. Luckily I have insurance through
my Union (even though I have not been able to work for years)
but it has a co-pay... He is a caring professional also, I
have had a Dr. in the past (O.D.) in my small town, who
refused to tell me the results of my infant (at the time)
son's, test results. Even though, I had to get him tested at
the hospital, until I paid him $45 for an office visit. I
threatened a lawsuit. His "office manager" called me
later to "suggest" that I find a different Dr. for
my family. I told him that I had already done so. I think I
may have told him a few things....but I did find a terrific
family Dr. in a neighboring town.