What Do Physicians Think?

I found this item at the Chicago Tribune by Lisa Schenker on the views of the American Medical Association on “Medicare For All” somewhat misleading:

Doctors gathered in Chicago for the American Medical Association’s annual meeting this week are increasingly finding themselves at the uncomfortable center of a national debate over “Medicare for All.”

A group of doctors, nurses and medical students protested the meeting, criticizing the association’s opposition to Medicare for All — the idea of expanding Medicare to cover all Americans. And on Monday, the doctors at the meeting heard a speech by Seema Verma, head of the federal Centers for Medicare & Medicaid Services, a Trump appointee who devoted a chunk of her talk to what she sees as problems with the proposal.

She told the audience, to applause, that Medicare for All would lead to higher taxes, lower payments for doctors and rationing of health care, among other things.

“We are deeply committed to helping those who need it, but while doing that, we must put the patients and their doctors in the driver’s seat to make decisions about their care, not the government,” Verma said.

So far the AMA has stood by its opposition to Medicare for All, also sometimes referred to as a single-payer system, even as it’s become a hot topic ahead of the 2020 presidential race. Democratic candidate Sen. Bernie Sanders, I-Vt., unveiled a bill earlier this year to move to a single-payer health care system. About 56 percent of Americans surveyed earlier this year by the Kaiser Family Foundation said they would favor all Americans getting their insurance from a single government plan.

I think it’s factually accurate but doesn’t really put the matter into perspective. Opposition to health care reform from the AMA in the 1960s almost prevented Medicare and Medicaid from being enacted. Opposition to reform by the AMA in the 1990s sunk the Clinton Administration’s attempt to reform health care as well. The Obama Administration succeeded in getting the Affordable Care Act passed, not the least reason being the payments to physicians written into the act. Paying for reform was instrumental in getting Medicaid passed in 1965, too.

But the AMA is not the powerhouse it was. In the 1950s 75% of physicians belonged to the organization; now 25% do. Ironically, the number of members has not changed a great deal. What has changed is the total number of physicians. In 1960 nearly all U. S. physicians were born and trained in the U. S. Now many are what are called “internationally trained physicians”, many from South Asia.

The other source of the AMA’s power is its custodianship of the Physician Specialty Codes and that it is relied on heavily by the Medicare system to determine the relative value of different procedures. You didn’t think those were determined solely by the federal government or the workings of the market, did you?

I would speculate that physicians are divided on M4A and will remain so. The devil will, of course, be in the details. A version of the plan which cuts reimbursement rates to the Medicare reimbursement rate will probably meet with greater opposition than one that doesn’t but I don’t believe any projection that has shown savings from M4A has ever assumed that reimbursement rates would be left alone.

I wouldn’t be surprised if there isn’t some internecine warfare among different medical specialties as specialists seek to preserve their proportionally higher reimbursement rates, one of the factors that distinguishes the U. S. health care system from European systems.