The AMA Endorses, Some Cold Water, but other signs of Movement

My good friend, Joanne Kenan at the New America Foundation writes about the AMA's endorsement. You should read the letter and her analysis. It is quite amazing.

Why does this matter? While the AMA represents a dwindling number of physicians, it is still the largest group. But, what is even more important, they have been opposed to health reform proposals like the House bill. This is the group the created the specter of socialized medicine. The AMA has lost members because it has grown conservative.

Now it did an about face. What caused it? Well, the bill gets rid of a payment method called the Sustainable Growth Rate (SGR). The SGR essentially required an across the board reimbursement cut when health care spending growth outpaced GDP growth. This has happened, and Congress has intervened to stop it. As Jon Cohn points out though, when you are sowing the seeds for future payment reform, keeping it in place just does not make sense.

The cold water comes from the CBO scores and testimony. I completely agree that the bill does not help to bend the curve. It does provide access and coverage. However, bending the curve is the ultimate goal. By investing in new ways to reimburse in Medicare and promoting more comparative effectiveness research (and thereby building on the stimulus act).

However, as Ezra Klein points out, hypocrisy is ripe. The basic tenant of the opposition to the bill is that it is too expensive. But when you try to ask them to control costs by actually using comparative effectiveness that includes things like cost effectiveness research as well, they flip out, saying you ration. Rural areas freak out if you try to save money by structuring things on a Medicare plus a certain percent basis, because they think Medicare reimburses them too low comparatively (sort of true). Every interest group comes in and has its needs, and it turns into a feeding frenzy.

Add in the idea floated by the Administration of precommittal, which is requiring Congress to accept a recommendation on an up or down vote, is something that is an anathema as well. Many of these very people criticizing these costs hate the idea.

Klein has the right idea when he says those who criticize should:

a) Support, as the CBO says you should, the eradication of the tax exclusion that protects employer-based health-care insurance;

b) Support, as Lewin and Commonwealth say you should, a public insurance option that can bargain at Medicare's rates;

c) Support, as the Office of Management and Budget and every health-care wonk in town says you should, one of the various policies floating around to give MedPAC authority to continually reform and modernize Medicare;

d) Support some form of aggressive cost-sharing that would make people extremely angry because it will save money by reducing their access to health-care services;

e) Support comparative effectiveness review that can judge not only the effectiveness but also the cost-effectiveness of various treatments, and give the federal government authority to use that data when deciding reimbursement rates.

A problem of course comes with the tax matter, which I have discussed at length. So I will just point to the Opinionator, which did a better job of aggregating than me!

Finally, there are other signs of hope. Remember Harry and Louise? They were the ads that torpedoed Clinton's bill (or at least are considered partly responsible). Now they have returned. But, now they are pro-reform. They are sponsored by PhRMA and Families USA, a strange mix, but clearly showing a level of consensus.

Another last sign of hope? Jon Cohn reports that the Politico has a scoop that the Senate Finance Committee is coming out with their bill. I hope it is strong (and I hope it has better tax policy than the House).

There are obstacles. The road is not easy, but if we get something, it is looking more positive that it will be only a first step. But, what a step it would be!