Doctors lift healthcare

The American Medical Association (AMA), which helped torpedo the Clinton administration’s effort to revamp the nation’s healthcare system 15 years ago, endorsed the House Democrats’ health bill on Thursday.

President Obama touted the physician group’s move, saying “these doctors are joining the chorus of Americans who know that the time to reform what is broken about the healthcare system is now.”

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Despite the high-profile endorsement, cost issues continue to hamper efforts to pass healthcare reform. On Thursday, Congressional Budget Office Director Douglas Elmendorf said that bills in both chambers would increase long-term federal spending on healthcare. Obama has stressed that a reform bill must rein in exploding healthcare costs.

Obama, who lashed out at special interest groups throughout his presidential campaign, has worked closely with congressional Democrats to court powerful healthcare groups over the last several months.

Obama and Democratic leaders on Capitol Hill are mindful of the fact that Clinton and every other leader who ever tried to fix the healthcare system by taking dead aim at powerful groups in the sector has fallen short.

Based on those lessons learned — which, as Obama likes to say, date back to Teddy Roosevelt — this time, Democrats have taken a different tack: Having physicians, hospitals, drug makers, insurance companies and other big-time players at the negotiating table for as long as possible.

Despite the myriad obstacles that remain to enactment of healthcare reform this year, the support of such a group as powerful as the AMA can only be seen as a positive sign for Democrats.

In a show of Speaker Nancy Pelosi’s (D-Calif.) excitement about AMA’s move, her office on Thursday issued a “breaking news” e-mail about the endorsement.

Rep. John Dingell (D-Mich.), who is the main sponsor of the health bill, said that “AMA’s support should not be underestimated. Quite honestly, it has been difficult to win the support of this organization going all the way back to the 1930s.”

For the healthcare groups, cozying up to Democrats or even taking the eyebrow-raising step of offering a public endorsement provides them with additional leverage as they lobby for or against portions of the bill.

The healthcare industry, too, recognizes that healthcare reform done the right way could mean access to a large, unserved market: the 47 million people who have no health insurance

The White House and congressional Democrats have also wooed the powerful seniors’ group AARP. An endorsement from that organization, which represents 35 million members from a highly motivated voting bloc, would be a huge boost to the Democrats. The AARP’s endorsement of President Bush’s Medicare prescription drug bill in 2003 was essential to its eventual passage.

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Meanwhile, big business groups such as the U.S. Chamber of Commerce have come out hard against major components of the Democrats’ healthcare provisions, such as a requirement that most employers offer health benefits or the creation of a government-run insurance plan.

Healthcare groups, however, have remained active participants in the Democrats’ process — even as their criticisms on specific issues have sharpened in recent weeks — much to the chagrin of their traditional allies in the Republican Party.

Instead, these would-be foes of reform have been spending money on advertising campaigns expressing general support for healthcare reform.

“Harry and Louise,” the fictitious middle-class couple who appeared in insurance industry ads that proved deadly to Clinton’s reform effort, are now appearing in a campaign funded by the Pharmaceutical Research and Manufacturers of America (PhRMA) and the liberal consumer group Families USA.

Yet on issues ranging from creating a government-run insurance plan to increasing the availability of generic prescription drugs to establishing tough limits on Medicare payments to providers, healthcare reform provides interest groups with innumerable reasons for opposition.

PhRMA this week issued a statement saying it “cannot support” opposing the House healthcare bill, which would lower what Medicare pays for medicines. The group added that “we believe that patient-centered healthcare reform is still on the right track to becoming law.”

The AARP said it was “pleased by the House TriCommittee’s healthcare reform bill” in one statement, but another cautioned Democratic senators that the bill approved by the Health, Education, Labor and Pensions Committee did not go far enough in easing access to cheaper copies of complex biologic drugs. Such drugs are made from living organisms and have been increasingly important to the practice of medicine.

With the House bill making its way toward a floor vote in less than two weeks and one Senate committee completing work on its portion of the upper chamber’s legislation, interest groups are sure to peel off. Obama and congressional Democrats are hoping to put that day  off as long as possible.

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Apart from the AMA and the American Nurses Association, no other healthcare interest group has endorsed any bills — indeed, some may indefinitely stay on the sidelines — but at a minimum, Democrats have postponed the kind of anti-healthcare-reform onslaught from interest groups that played a key role in crushing Clinton’s initiative.

Though not conclusive pending the shape of whatever final healthcare bill the House and Senate may send to Obama, the AMA’s endorsement is the best evidence yet that the president and his allies on Capitol Hill chose the right approach to dealing with their potential enemies by keeping them close.

AMA is not the first healthcare interest group to stand beside Obama or come to agreements with congressional Democrats on reform, though other groups have withheld their explicit support for the Democrats’ entire platform.

Most recently, the American Hospital Association (AHA) and two other hospital groups appeared at the White House with Vice President Biden to announce an agreement under which the hospitals would not fight $155 billion in proposed cuts in their Medicare and Medicaid funding.

Before the hospitals, it was PhRMA promising Obama and Senate Finance Committee Chairman Max Baucus (D-Mont.) that they would provide discounted drugs to Medicare beneficiaries and agree to budget cuts that combined are valued at $80 billion. Notably, AARP CEO Barry Rand spoke at the White House press conference announcing the agreement. Rand also appeared in Alexandria, Va. at a healthcare reform event on Thursday with Biden, Health and Human Services Secretary Kathleen Sebelius and White House health adviser Nancy-Ann DeParle.

The AMA-endorsed House bill would enact the group’s foremost priority: a permanent fix to a Medicare payment system that annually calls for doctors fees to be cut. The Senate does not appear poised to follow suit, making an enthusiastic AMA endorsement of its bill less likely.

For the hospitals, the opposite is true. The Senate bill being drafted is understood to track closely with what the White House wants, while the House measure does not. PhRMA is in a similar situation as the hospitals.

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