Wednesday, June 17, 2009

Doctors Just Want to Be Doctors

by Brooke Jarvis


When President Obama discussed health care reform with the physicians of the American Medical Association on Monday, he was speaking to a group considered one of the strongholds of opposition to reform, particularly any that includes the so-called “public option” (creating a government-sponsored insurance plan, modeled after Medicare and available to all Americans, that would expand options and reduce costs by competing with private plans on a national insurance “exchange”). The AMA has a history of opposing major changes to health care, dating back to the advent of Medicare in the 1960s, and had gone on record the week before opposing any public plan—saying, in comments sent to the Senate Finance Committee, that “the introduction of a new public plan threatens to restrict patient choice by driving out private insurers.”

It’s commonly assumed that the AMA’s stance reflects the beliefs of a majority of the nation’s physicians, many of whom do benefit from the runaway costs of health care. Wouldn’t doctors, concerned that reform would drive down costs, uniformly stand with insurance and pharmaceutical companies in defense of the status quo?

But this view is based on a belief that all doctors like the way the current system has, as President Obama put it, “taken the pursuit of medicine from a profession—a calling—into a business.”

The truth is, they don’t.

Despite its prominence and lobbying budget, it’s important to remember that AMA doesn’t speak for all doctors—fewer than a fifth of practicing physicians, in fact, and that number appears to be dropping. Meanwhile, membership is growing in physicians’ groups that have a different perspective. Sixteen thousand doctors are members of
Physicians for a National Health Program, dedicated solely to research, education, and advocacy in support of a universal, comprehensive, single-payer system.

Or, take the
National Physicians Alliance. Recognizing that “some physician organizations prioritize political agendas concerned with physician compensation and malpractice over medicine and health issues,” the NPA’s mission is to “restore physicians' primary emphasis on the core values of our profession: service, integrity, and advocacy.” When the AMA came out in opposition to the public option last week, NPA policy director Dr. Chris McCoy quit—publicly. In an open letter to the AMA, he said he could no longer be a member of an organization that encouraged physicians to “have a vision of themselves as money-generating profit centers rather than professionals serving the public good.”

On Monday, a coalition including the National Physicians Alliance, The American Academy of Family Physicians, the Doctors Council, and five others released a
joint statement supporting the creation of a public option, saying it would increase affordability and promote better and more collaborative care. Together, the associations represent 215,000 doctors.

Doctors for America, another of the signatory coalitions, offers a
forum for physicians to express their frustrations and hopes. The voices that emerge aren’t worried about making more money, but about being good doctors:


Dr. Hamid Rabiee, California: “I want health reform that takes the profit out of health, [and] changes the health industry to health care.”
Dr. Robyn Liu, Kansas: “I want health reform that is about health and puts patients first. I want incentives that are aligned with patient health and not with performing more tests and procedures.”
Dr. Robert Patterson, Indiana. “I want health reform that allows me more time to know the patient I am serving better.”
Dr. Elizabeth Powers, Oregon: “We must measure the efficacy of any new system by the health of our entire population. Inequities based on race, socioeconomic status, insurance status, etc. must be eliminated.”
Dr. Bonnie Gifford, West Virginia: “I want health reform that removes the business model from caring.”


The AMA isn’t a monolithic bloc, either, and many voices within are speaking out for change. Though the association hasn’t wavered in its opposition to expanding a government-run system like Medicare, its policymaking group today voted to support “health system reform alternatives.” Dr. Nancy Nielson, the group’s outgoing president, says that the AMA is not categorically opposed to a public plan and encouraged members not to allow themselves to be cast as “naysayers” to reform. She also reminded the group that it should focus more on patient care and less on defense of the insurance industry.

It’s clear, though, that many doctors don’t need that reminder. Fifty-nine percent of them support a national health insurance program, according to a March poll published in the Annals of American Medicine. It’s the system that makes the most sense to doctors—and patients—of all political backgrounds, as YES! has reported. All over the country, they’re pushing for universal, fair, and public health care that values patients over profits and health over industry.

They’re the ones President Obama was talking to when he said that the pursuit of money “is not why you became doctors. That is not why you put in all those hours in the Anatomy Suite or the O.R. That is not what brings you back to a patient's bedside to check in or makes you call a loved one to say it'll be fine. You did not enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers - and that's what our health care system should let you be.”

Even at the AMA, that got a standing ovation.

Photo: Members of the National Physicians Alliance in front of the Capitol. Photo courtesy of the NPA.

11 Comments:

At 9:57 AM, Anonymous Docs supporting the public plan option said...

Thanks Brooke for bringing to light the reality than most physicians support a public health insurance option- polling in the past indicate at minimum 60% of physicians support it. The reason we do is because we know intimately what our patients deserve- guaranteed quality affordable health care for all. When you have a system that ultimately puts profits over patients, and is not incentivized to provide preventative or comprehensive care, it is no wonder we rank so low on so many basic health indices. We can do better. And there are many doctors who are working to make sure that we do!

Dr. Manel Silva
Director of NY National Physicians Alliance

 
At 10:56 AM, Blogger Brooke Jarvis said...

A new Gallup poll released yesterday tells us that Americans trust doctors more than any other group to advise them about the best way to reform health care, with 73 percent placing their confidence in doctors.

All the more reason for to be clear about what most doctors are saying!

 
At 12:06 PM, Anonymous S.A. said...

We doctors are generally business-naive folk. Many would like to remove business from medicine so we can provide good care but that isn't going to happen. Common sense tells us that health care is a business. Money will be made on health care. If doctors don't make that money, someone else will.

Doctors already lost big time by failing to be business savvy back when the idea of "health insurance" took on its current grotesque form. We need to now preserve our ability to make a decent living and our basic right to self-determination.

I am 100% for health care for children and not opposed to government health care plan for universal coverage, but I fully oppose any government plan that forces doctors to participate.

Personally, I found the President's comments to the AMA very concerning for the following reasons:

1) President Obama, in speaking to the AMA, referred to the current
health care system as "a model that has taken the pursuit of medicine
from a profession -- a calling -- to a business." As you pointed out in your blog, he went on to say
"That's not why you became doctors. That's not why you put in all
those hours in the Anatomy Suite or the O.R. That's not what brings
you back to a patient's bedside to check in, or makes you call a loved
one of a patient to say it will be fine. You didn't enter this
profession to be bean-counters and paper-pushers. You entered this
profession to be healers. (Applause.) And that's what our health care
system should let you be. That's what this health care system should
let you be. (Applause.)"

Although on the surface he is praising the nobility of a life in
medicine and promising that doctors can be unburdened by his plan
(hence the applause from the AMA), I resent these comments. Who is he
to tell us why we logged hours in the anatomy lab? Why should doctors
not be free to practice medicine not only as a calling but also as a
business? Are we to be ashamed if making a good living is part of the
reason we chose this difficult road?

2) The President went on to say "Now, that starts with reforming the
way we compensate our providers -- doctors and hospitals. We need to
bundle payments so you aren't paid for every single treatment you
offer a patient with a chronic condition like diabetes, but instead
paid well for how you treat the overall disease. We need to create
incentives for physicians to team up, because we know that when that
happens, it results in a healthier patient. We need to give doctors
bonuses for good health outcomes, so we're not promoting just more
treatment, but better care."

This is problematic for the following reasons:

First, it isn't easy to come up with a good way to pay based on "how
you treat an overall disease. Let's consider President Obama's
example of a chronic condition, diabetes mellitus, It has been
proposed that doctors who care for patients with diabetes receive more
money if their patients achieve their hemoglobin A1C (HbA1C) goal.
HbA1C is a blood test which gives an estimate of a patient's average
blood sugar over a three-month period. This sounds like a great idea,

 
At 12:07 PM, Anonymous S.A. said...

continued:

not to pay doctors based on how many times they see the diabetic
patient but rather how well they are able to help the patient to
manage their diabetes. However, a deeper look at this idea reveals a
major problem: Doctors who are willing to care for the poorest and
sickest diabetics are punished. Such patients will almost never
achieve their HbA1C goals, so any physician who wants to make more
money will avoid them. This isn't just the case with diabetes.
Basing payments on achievement of "successful overall care" will
general reward the doctors who decide to care for those patients who
are the least sick and have the most social resources.

Second, why should the government determine how doctors get paid?
Lawyers often get paid by the hour. It might be good for most
Americans if we found some merit-based way to pay lawyers instead of
paying them on the basis which they choose, but no one would suggest
such a thing. It would be an obvious affront to their rights.
Shouldn't we doctors also be free to charge however we want? It's not
as if anyone is forced to pay us if the doctor down the road is
willing to take a lesser payment.

I've no problem with the government-sponsored insurance paying a
certain way and other private insurers following suit. However, I
strongly oppose being forced to participate in these programs. I have
a right to sell my services however I choose, whether that be
accepting state issued health care or hanging a sign on my front door
and charging cash only to anyone who wants to walk in and accept my
care. I recognize that participating may become the only way to make
a good living, but as physicians, we must have the same basic right to
self determination as other Americans.

The state of Massachusetts, a harbinger of what is likely to come
nationwide, is currently considering forcing physicians to join
accountable care organizations (http://bit.ly/tLAtB). I honestly
wonder at how this could happen in America.

3) The President also said "we need to rethink the cost of a medical
education, and do more to reward medical students who choose a career
as a primary care physician -- (applause) -- who choose to work in
underserved areas instead of the more lucrative paths. (Applause.)
That's why we're making a substantial investment in the National
Health Service Corps that will make medical training more affordable
for primary care doctors and nurse practitioners so they aren't
drowning in debt when they enter the workforce. (Applause.) Somebody
back there is drowning in debt. (Laughter.)"

This too was positively received by the AMA crowd, but I am concerned.
In some countries, state-sponsored medical education goes
hand-in-hand with forcing doctors to provide care with very low pay.

It seems to me that you have cherry picked quotes and sites to make it seem as though most doctors are oblivious to the obvious financial and constitutional rights implications of the plans currently under consideration. I sure hope that today's doctors are more savvy than that. Caring for patients is not mutually exclusive with caring for ourselves.

 
At 10:06 AM, Anonymous Anonymous said...

Thank you Brooke! The vast majority of physicians are dismayed by what the insurance companies and other industry businesses have done to medicine. Medicine is a calling; we are professionals and healers. Many of us give away our time for free, and work long hours.

 
At 10:13 AM, Anonymous Honesty in Medicine said...

Thanks Brooke!

Everyone should be aware that the American Medical Association (AMA) does NOT represent most physicians. The majority of physicians are not members of the AMA.

Quote from a report:

"Physician membership in the group has DECREASED TO LOWER THAN 19% of practicing physicians.”

Source :
Report of The Board of Trustees 20 - A-06
AMA

 
At 10:18 AM, Anonymous Anonymous said...

In fact, over half of physicians support Single-Payer Healthcare reform!

See: http://www.pnhp.org/facts/single_payer_resources.php and 
http://www.healthcare-now.org/hr-676/

Only a single-payer approach to healthcare reform will end the inhumanity of our failed healthcare insurance system, where profits are more important than patients’ health, and where people die because of it.

The outcome of this fight will affect Americans for years to come!

 
At 10:20 AM, Anonymous A frustrated physician said...

There are two main arguments in favor of Single Payer health care.

THE MORAL ETHICAL ARGUMENT

The first is the ethical moral argument. Health insurance companies make their profit by denying health care to sick people. That is immoral and unethical.

THE ECONOMIC ARGUMENT

The second compelling argument is economic. Our current system of for-profit corporate health insurance has created an unbearable economic burden on the nation.
There are over 1500 separate health insurance companies operating under different sets of rules creating a huge 30 % administrative overhead. For comparison, administrative overhead for Medicare is only 2%.

By converting to a single payer system, we immediately save 300 billion dollars in administrative overhead. Medicare is a 40 year example of a successful single payer system which has an administrative overhead of 2%, not 30%.

As a nation, we are now paying twice what other countries pay for health care, yet we do not have universal health coverage here in the US. 50 million Americans are without healthcare and 87 million Americans without health insurance at some point in the past 2 years. 62% of bankruptcies currently filed in the United States are because of medical bills.

Despite the costs we pay, the United States ranks LAST on a list of 19 industrialized nations in preventable deaths, and 29th of 37 in infant mortality. The World Health Organization ranks the US at 72nd for healthcare accessibility and efficiency. We can no longer maintain the status quo for the ways we currently provide and pay for health care.
WHY WE DON'T HAVE SINGLE PAYER NOW

These two arguments in favor of a single payer heath insurance system (moral and economic) are so compelling, that one must conclude the only reason we don't have single payer now is because of lack of representative government. The obvious conclusion is that our government does not serve the people who elected them. Rather, our elected government officials serve the special interests of the health insurance industry and other corporations who make massive campaign contributions.

ASK your Senators to support S 703, The American Health Security Act.

ASK your Representative to support HR 676, The United States National Health Insurance Act.

 
At 10:26 AM, Anonymous C. W. said...

Regarding Single Payer healthcare reform, it's important to educate the public to counter the scare tactics of the insurance companies. HERE ARE THE FACTS:

Single-payer systems, in various forms, work well in many, many countries around the world---and these countries have better health outcomes than the US. See the table comparing the US with other countries here (you may be surprised): http://en.wikipedia.org/wiki/Healthcare_in_Sweden

I think the US public needs to know that:
Single-payer healthcare is NOT government-run healthcare.
Single-payer healthcare is NOT socialized medicine.

Please take a look at the article “Health Reform for Beginners: The Difference Between Socialized Medicine, Single-Payer Health Care, and What We'll Be Getting” http://voices.washingtonpost.com/ezra-klein/2009/06/health_reform_for_beginners_th_1.html

Quoted from the article:

“Socialized medicine is a system in which the government owns the means of providing medicine. Britain is an example of socialized system, as, in America, is the Veterans Health Administration.

“In a socialized system, the government employs the doctors and nurses, builds and owns the hospitals, and bargains for and purchases the technology. I have literally never heard a proposal for converting America to a socialized system of medicine. And I know a lot of liberals.

“SINGLE-PAYER HEALTH CARE IS NOT SOCIALIZED MEDICINE. It's a system in which one institution purchases all, or in reality, most, of the care. But the payer does not own the doctors or the hospitals or the nurses or the MRI scanners. Medicare is an example of a mostly single-payer system, as is FRANCE. Both of these systems have private insurers to choose from, but the government is the dominant purchaser. . . . The term refers to market share, not federal control.”

So, when we talk about a single-payer system, we don’t mean socialized or government-run healthcare; nor do we mean the Canadian system.

I think we should look carefully at the healthcare systems in place in Taiwan and the Netherlands, Norway and other countries.

 
At 10:30 AM, Anonymous Anonymous said...

A new study shows that SINGLE PAYER HEALTHCARE REFORM WOULD BE A MAJOR STIMULUS FOR THE US ECONOMY and would provide:

** 2.6 Million New Jobs,
** $317 Billion in Business Revenue,
** $100 Billion in Wages, and
** $44 Billion New Tax Revenues


Here’s the study: http://www.calnurses.org/research/pdfs/ihsp_sp_economic_study_2009.pdf

See the YouTube clip (5 minutes) about how to pay for healthcare reform “HR676 - The Single Payer Solution, Part 4 of 4: http://www.youtube.com/watch?v=Nxi7DnCH3zk It’s about public financing and private delivery.

It’s clear that single-payer is the solution, not only in terms of providing quality care for all, but also economically!

We must all stand up and ask our Senators and Representative to have the Congressional Budget Office (CBO) score the single payer plans. They are resisting as it would then become clear thet single payer is the only financially sound way to go for all Americans. Of course, it's the only ethical way to go as well.

 
At 10:33 AM, Anonymous Anonymous said...

I take objection with the thought that the health care industry makes money by rejecting to care for their patients.

Like any other service in the US, if the health care provider does not provide the service that is outlined in the contract with the purchaser, the provider would be subject to breach of contract or fraud litigation.

The provider market is a competitive business. If a provider routinely deny claims, then the purchaser can look for another plan. I can guarantee at my work place if a enough people complain about the service of our provider, we will look for another provider. Plus we look for the provider which provides the best value, which helps keep costs in check.

Under socialized system (which is where will be headed with a public option) there is no competition. Health care will be administered just as education is. "No child left behind?" Try applying that to health care. No patient left behind as long as the numbers are favorable. Scares the hell out of me personally and it should scare more people as well.

Under a public system the supply of service will not increase, so we will have more demand chasing a similar (if not decreasing) supply of service. Claims will be denied under that system because we do not have unlimited resources, but instead of allowing purchasers to choose their level of service, the government will.

Folks, we are headed down a very scary path where we might lose our leadership in health care innovation as the government takes over. The free market economy which has provided us with so much prosperity is starting to unwind.

 

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