By Jeffrey Young - 08/15/09 01:25 PM EDT
Though the measure includes $240 billion worth of increased Medicare payments for doctors, it also would create a government-run “public option” insurance program that would compete with private insurers, a prospect that unnerves healthcare providers worried the government will not pay them enough for their services.
The document also seeks to reassure members that the AMA does not support nationalized health insurance, outlawing private insurance or mandatory end-of-life counseling, giving bureaucrats the authority to dictate what treatments a doctor prescribes or rationing care.
The AMA is the only major healthcare industry lobbying organization to endorse the House bill.
Although groups such as the Pharmaceutical Research and Manufacturers of America (PhRMA) and the American Hospital Association (AHA) have generally supported the healthcare reform efforts of President Barack Obama and Congress, the AMA went further by offering explicit support for a piece of legislation.
By getting out in front of other healthcare groups last month, the AMA says it is well situated to influence changes to the reform bill as it moves through the legislative process. “We believe our support helps put us in a very favorable position to craft a single bill for final passage,” the document says.
Medicare funding is vital to physicians. The complex formula that calculates how much Medicare pays doctors is flawed and would have required the government to cut payments in recent years by as much as 21.5 percent. The House bill includes a new payment policy and more than $240 billion in spending to implement it.
Even though congressional Democrats oppose one of the AMA’s other big priorities – caps on malpractice lawsuit damages – getting a new Medicare payment formula enacted would be a major victory for the group.
But the move to endorse the House bill carries risk for the AMA, which must bring skeptical members on board with a strategy that has caused consternation among those physicians worried about broadening the scope of the federal government’s involvement in the healthcare system.
The AMA is not alone in dealing with a membership split over the direction Obama and his allies in Congress are taking healthcare reform.
When the AHA joined the AMA, PhRMA, the Advanced Medical Technology Association, America’s Health Insurance Plans and the Service Employees International Union to promise Obama they would find $2 trillion in savings in the healthcare system, members of the AHA and other groups pushed back.
Likewise, physicians and their lobbying representatives are divided over the House bill. The American College of Surgeons and the American Academy of Family Physicians have endorsed the measure, for example, while the American Association of Neurological Surgeons and a handful of state medical societies oppose the bill.
The anxiety that underlies this divide is evident in the “frequently asked questions” for which the AMA provides its answers in its document.
“Why is the AMA supporting H.R. 3200?” the first question says. “H.R. 3200 contains many elements that reflect AMA priorities for health system reform,” is the reply.
But via subsequent questions and answers, the AMA makes clear that there are elements of the House bill it does not expect to survive the legislative process. Indeed, the group appears to be counting on it.
On the public option in particular, the AMA writes, “We believe that, as the legislative process continues, alternatives and modifications to the public option will be considered and the final product will be considerably different than the provisions contained in the original version of H.R. 3200.”
The AMA’s gamble could well pay off. The Senate Finance Committee – the only of Congress’s five healthcare committees yet to introduce a bill – is trying to hash out a bipartisan measure that would not include a public option.
Even with a public option, the AMA pushes back against charges it has endorsed “socialized medicine” by endorsing the House’s measure. “The AMA continues to oppose nationalized health insurance, and we continue to express opposition to elements of public plan proposals that we believe could lead us down the road to a single-payer system or ‘socialized medicine,’” the document says.
The AMA also tackles some of the more extreme accusations against the healthcare reform bill.
“H.R. 3200 would not provide the government with the authority to decide what medical treatments patients will receive,” the document says. “The bill would not ration care; it would expand access to health care coverage and increase the information needed to support strong clinical decision-making.”
The AMA also notes that the end-of-life counseling benefit the bill would create is voluntary, contrary to assertions by conservative critics that these consultations are intended to encourage elderly and sick people to submit to euthanasia.
Addressing email campaigns by critics of the Democratic healthcare reform proposals on rationing and other issues, the AMA described such messages as “extreme claims based on cursory readings of the legislation supplemented by conjecture and misinterpretations that do not reflect an accurate understanding of current law, medical practice or insurance regulation.”
“As is true with all email spam, messages that are repeatedly forwarded from an unknown original source should not be trusted. Physicians are encouraged to consult with the AMA, their state societies and specialty societies about the accuracy of any legislative interpretations that cause them concern,” the document says.