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Dear AMA: I Quit!
Dear American Medical Association,
I recently had the opportunity to read your response to the Senate Finance Committee proposal [pdf] for health care reform, and it is clear to me that I cannot remain a member in your organization. Please remove my name from your membership rolls, effective immediately.
In reading the response, I was frustrated and disheartened by the fact that you couldn't get through the second paragraph before bringing up the issue of physician reimbursement. This merely highlights how the AMA represents a physician-centered and self-interested perspective rather than honoring the altruistic nature of my profession. As a physician, I advocate first for what is best for my patients and believe that as a physician, as long as I continue to maintain the trust and integrity of the profession, I will earn the respect of my community. The appropriate financial compensation for my endeavors will follow in kind.
I encourage the AMA leadership to read Atul Gawande's recent article describing how physician culture drives up the cost of health care without benefiting patient outcomes. At the heart of this problem are physicians who have a vision of themselves as money-generating profit centers rather than professionals serving the public good. The AMA represents, and encourages, this mindset with its single-focus on physician reimbursement over all other health care reform issues.
However, the most disappointing aspect of the AMA's response to the proposed health care reforms was the opposition to the public health insurance option. I simply cannot support an organization that opposes the public health insurance plan for my patients. Instead of advocating for patients, the AMA is supporting the private insurance industry, which has been a driving force in creating the dysfunction health care system we have today.
But this should not have surprised me: when health care reform has been necessary, the AMA has always stood on the wrong side of history. The AMA opposed the creation of Medicare in the 1930s, when it was first proposed as part of Social Security. The AMA opposed Medicare again in the 1960s, going as far as to hire an actor named Ronald Reagan to read a script to the AMA Auxiliary declaring Medicare as the first step toward socialism, and concluding with the statement that if Medicare were to become law, "One day, we will awake to find that we have socialism.... One of these days, you and I will to spend our sunset years telling our children, and our children's children, what it was once like in America when men were free."
That was 50 years ago ... and none of that has come to pass. And yet this year, the AMA argues that a public health insurance plan will destroy the private insurance market. I challenge the AMA leadership to cite a single example of an industry where involvement by the government has lead to the elimination of private enterprise. This has not been the case with the creation of public police forces in the second half of the 1800's (private security companies still exist), we have a robust system of public and private colleges existing the same market, and bookstores still sell books despite the presence of public libraries. A mix of public and private enterprises in the market is a truly American solution to ensuring equal access, as well as competition to drive quality improvement. In fact, the creation of the public health insurance option will *increase* competition, as demonstrated by the AMA's own studies showing that 94% of health insurance markets only have 1 or 2 providers in the market.
It would appear that the AMA's position against the public health insurance market is driven by out-dated political ideology that blindly supports private industry rather than a careful examination of the facts of the current situation.
The AMA seems to be fixated on the fact that Medicare and Medicaid payments are lower than other payers. Let's go back to the history again: because the AMA opposed the creation of Medicare, physicians were not represented at the table when the system was designed. As a great policy wonk once said, "If you're not at the table, you're on the menu." And thanks to the dismal leadership and short-sightedness of the AMA in the 1960s, physicians were not a full partner in the creation of Medicare. And we're still feeling the reprocussions of that today. And yet now in 2009, the AMA is going to repeat that mistake by opposing the public plan.
The health care system is broken, and physician leadership is needed now more than ever to help direct the reforms that are desperately needed. However, the AMA has not shown itself to be the organization to provide that leadership in restoring the profession of medicine. New physician leadership is needed to fully achieve a reformed health care system that works for our patients and for our country.
Sincerely,
Chris McCoy, MD
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Dear Doctor,
Maybe you can found a new "AMA" organization and I applaud you for your altruism.
Also, I'm wondering if the Obama Health plan includes coverage for dental issues. I was a shocked when I was told in plants are not covered by my Delta Dental insurance plan. However, dentures are. Well, more late Baby Boomer Blues.
ArtistMom
I can remember when the Doctors didn't want Medicare. Now they think its wonderful. The whole medical system is broken in many places. A doctor once wanted to help his patients to live and to heal and would take about anything in payment. No i don't think it is right to think they should not get good payment. But they should remember that they once went into the business to help people, not to help themselves. Most doctors that I deal with are for the patient. I agree with Dr. McCoy
It's not just doctors, insurance companies can abandon people too. You can pay them for years and if you really have an illness they will disqualify you from getting payments for doctor and hospital.
There are a lot of people that are in high money places that cannot put themselves in the places of people that don't have big salaries. We don't want to have a county that has a great divide between the rich and the poor. That's why you have uprisings and people dissatisfied with their country they live in.
I find it troubling that this article has been so well received since it reekks of socialism. If young medical school students didn't have a "profit motive" I would assume that we would have a lot fewer qualified doctors in this country. I have exposure to patience world-wide and they all have an overwhelming appreciation for the U.S. medical system. Please, do not let the government in!!!
"Overwhelming appreciation for the U.S. medical system"? How out of touch with reality are you?!! What world are you living in?! You are absolutely wrong! You must think the police should be privatized too! I have lived in Germany, Japan, and England. None of these countries, nor other industrialized countries, appreciate the U.S. medical system. They are actually VERY VERY glad they don't have the system we have here. Until I came to the U.S., I have never thought twice about going to the doctor. Having lived in the United States for some time now, I have come to wait until I get very sick before going to the doctor (and I have pretty good employer-based health insurance compared to most Americans), after which I have to call my insurance company over and over again to see why they are not covering various procedures and doctor visits! This is, by no means, an uncommon experience in the United States! Millions of insured Americans experience this, let alone the millions of uninsured Americans! The U.S. medical system is nothing to brag about! Only Americans are complaining about affordable health care among countries in the industrialized world. In fact, the United States is seen as the worst example of providing access to health care in the industrialized world! That is a fact, not an opinion! Just look it up!
"I have exposure to patience world-wide and they all have an overwhelming appreciation for the U.S. medical system."
I don't think so. USA is ran ked 37. Real patienTs are not going to the USA for medical reasons.
Excellent article!
Am I afraid leaving a mound of debt to my grandchildren due to single payer healthcare? Of course NOT!! I don' want leave them the system we have today!!! UP WITH SINGLE PAYER!!!
Are you a healthcare professional who is committed to a robust public health plan option? Please join us in petitioning Congress!
www.docsforapublicplanoption.org
We are a diverse group of healthcare professionals and students of the health professions that support the choice of a public health insurance plan as an essential component of comprehensive health care reform this year.
Dr. McCoy:
I also quit the AMA - as a medical student when I realized that the organization sells physicians' license numbers and personal information to health information companies so that pharmaceutical companies can track how many prescriptions individual doctors are writing for their products and can respond with gifts and promotions accordingly.
Aaron Fox, MD
Bronx, NY
being poor,without any health insurance,i appreciate your political stance, i recently encountered a medical setback,and have been told" sorry, nothing we can do at this time, without a credit card",which, being poor, Im without that too., and since the fcc took away my analog broadcasts(curry county oregon," remember us, we were bombed during ww2" ,and soon to be bombed again,n.k.,maybe you didnt know that), I missed the evening news that explained the latest stab , of a plastic fork into the armored side of the health insurance lobby.
Now is the time to achieve the inevitable single payer system, which also offers the only way to “pay†for universal healthcare without net additional costs. Only with single payer can we eliminate the 30% (or higher) cost in the current dysfunctional system which is devoted to: 1-administration of excessively complicated reimbursement in a system whose first question is always “What is your form of payment?†instead of “What is wrong with you [the patient]?/How can we best treat you?†2-insurance company case management/denial systems. 3-massive and unnecessary billing/collections systems. All approaches currently contemplated in Congress are certain to fail because: 1) They all retain & are built on the current failed private insurance system; 2) They all look for “savings†and “financing†by squeezing & starving hospitals, physicians & other providers; 3) they all continue to accept the status quo favored to protect excessive profits for prescription drug producers.
The AMA is not an advocate for the American people.
They exist to protect their own. Just look at the incompetents they have retained and protected. That's a list that will make you sick.
Good for you, Dr. McCoy. Good for you.
Why are doctors being portrayed as evil money hungry pawns of insurance companies. I have never met a physician that didn't have the patient's best interest in mind. Perhaps it is because I am a resident and have only come in contact with academic physicians for the most part. But reading these posts saddens me. Most of us are science heads who wanted to help people but at the same time wanted to do something that we enjoy and make a good living. Honestly, what other career can you bury your nose in books and work your butt off with a guarantee that if you hard work it will pay off. This is no elite club. Work hard, get good grades and test scores in college, apply, get in med school, take out 150-350K in loans and 7-10 yrs later you will make a good living. What's wrong with that? Why am I a greedy SOB with God-complex just because I chose to give up my twenties to take care of people?
It's not that a majority of doctors are, but those who speak loudest for them are quite often, hence this complaint of the AMA.
Remember who you're defending and who you're not =]
Because saints and martyrs are not supposed to be living in mansions and eating full meals. They are supposed to die early on the cross. What's wrong with you?
Because of stuff like this?
Ex-Hospital CEO Battles Reform Effort
http://www.washingtonpost.com/wp-dyn/content/article/2009/05/10/AR2009051002243.html?hpid=topnews
The Cost Conundrum
What a Texas town can teach us about health care
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
I love this divide between the physicians and non-physicians. Nice statement relm one! I am tired of the public trying to pigeonhole physicians into what and who we are supposed to be. We are all not one and the same. Each of us goes into medicine for different reasons, hence different specialties. "saints and martyrs?" What hole is your head in maddocbrown? By the time we are out of medical school, we have the debt similar to that of running 3 separate lives. Not only do we owe more than $150,000, but now we owe for a house and the overhead to run a pracitce. I have the next 30 years of paying off these debts after I have sacrificed my twenties. I should be making at least 3 times more than your high school education. All docs live in mansions? Oh yeah, I remember that MTV Cribs episode where they featured all of these doctor's homes. They were fantastic!
I do not feel bad for charging patients what I do. Why should I when they don't think twice of spending $9 on a pack of cigarettes. Then I see them with their cigarettes throwing away money into a slot machine in a casino. Then they're at Walmart buying the new ipod. How about spending a good chunk of money to see a ball game? Or all that cash on alcohol that leads to addiction and liver disease? Oh yeah, and having no problem buying oxycodone on the street. What I am trying to say is, people are out and about spending money on nonessentials. Why when it comes to your health is there this sense of entitlement? How come no one attacks the lawyers, car mechanics, sport figures and especially the insurance companies? They all charge an arm and a leg for their services, and the last time I checked, they receive what they bill. Do you know what we as physicians have to do? We have to overcharge our services. Otherwise the insurance company will pay the lowest that they can get away with and pocket what you and your employer pay anyway to be covered. Oh you didn't know that. All you see is a huge bill. Well know that the insurance companies have created this system that forces us physicians to overbill so that we can collect what is the standard payment.
I recently became a US citizen after having emigrating from Canada 10 years ago. I like living in the US or I wouldn’t have chosen to become a citizen. However I absolutely miss the Canadian healthcare system. In Canada there is no annual, enrolment, confusing bills, overwhelming administrative complexity with doctors, pharmacists, dentist, hospitals etc. etc. When I sought care in Canada I would go to the doctor of my choice and continue to see them for as long as I liked them. I never received a bill of any sort. Because I would see the same physician for decades they would know me. The care became tailored to me as a person and was much more focused on keeping me from getting sick than treatment after I became ill. I did not visit my physician and get asked for a co-pay before they saw me, and then get bills for multiple lab tests and the physician and have to try to keep track of all this. What a waste of time and money. In Canada they do not send you for all the unnecessary tests like they do in the US to jack up revenue and avoid litigation. So I am telling America flat out to get over the irrational knee jerk reaction at the mention of a socialized healthcare. It is in the nation’s best interest to have this as an option.
The nation does not make decisions here. Sorry.
Thank you, Dr. McCoy.
It is so nice to see this. I sometimes feel that physicians don't really care about their patients' health as much as they care about their patients' money.
On November 19, 1945, only 7 months into his presidency, Harry S. Truman gave a speech to the United States Congress proposing a new national health care program. In his speech, Truman argued that the federal government should play a role in health care, saying "The health of American children, like their education, should be recognized as a definite public responsibility." One of the chief aims of President Truman's plan was to insure that all communities, regardless of their size or income level, had access to doctors and hospitals. The statistics in Harry S. Truman's speech demonstrated the urgent need for such measures: "About 1,200 counties, 40 percent of the total in the country, with some 15,000,000 people, have either no local hospital, or none that meets even the minimum standards of national professional associations. "
AND WHO FOUGHT HIM TOOTH AND NAIL? THE AMA. THE MEANEST ORGANIZATION IN THE USA.
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