At the annual meeting of the AMA House of Delegates in Chicago, President Obama made an appearance to court physician support for his ideas for a comprehensive, government-directed “overhaul” of American medicine. Reportedly, he got a standing ovation from polite delegates, though there was a smattering of “boos” when he expressed opposition to limits on malpractice awards.
“Now, just hold on to your horses here, guys,” he told doctors when they applauded him for sympathizing with their worries about lawsuits. “I want to be honest with you. I’m not advocating caps on malpractice awards—which I personally believe can be unfair to people who’ve been wrongfully harmed.”
Obama called opponents of his plan “naysayers,” “fear-mongers,” and “peddlers of ‘Trojan horse’ falsehoods.” One such opponent is Representative Tom Price, M.D., of Georgia, an orthopedic surgeon, who calls the Obama proposal a “government takeover” that will set up a rationing board.
Obama stated publicly, for the first time, that his proposed “reshaping” would cost “about $1 trillion over 10 years.” That would include covering almost 50 million Americans who don’t have insurance. But not to worry: he ticked off $950 billion in hypothetical savings. These include cutting payments to hospitals for care of the uninsured, cuts in overpayments to Medicare Advantage plans, “adjusting” Medicare payments to reflect new advances, introducing generic biologic drugs, and reducing preventable hospital readmissions. This doesn’t count savings from computerization, prevention, and other things that the Congressional Budget Office can’t score.
There would also be revenue increases, as by “modestly limiting” the tax deductions of the “wealthiest Americans.” That should bring in $300 billion over 10 years for the $635 billion Health Reserve Fund.
Obama is for the “public option” and individual and employer mandates (“bearing a responsibility to own health insurance”). Not mentioned in the speech is his new “openness” to the idea of taxing some people’s health insurance benefits for the express purpose of subsidizing insurance for others. John Goodman notes that the Obama campaign spent hundreds of millions of dollars attacking John McCain for proposing to tax insurance benefits. Goodman explains the differences in proposed changes to the tax treatment of health insurance.
The huge cost of workers’ health care was “a big part of what led General Motors and Chrysler into trouble,” Obama said. Thus, the cost of not enacting his plan is higher than the cost of passing it, he asserts.
Obama promises to help doctors by seeing to it that “doctors can pull up on a computer all the medical information and latest research they’ll ever need to know to meet patients’ needs.” (No need for patients to tell every doctor they see their medical history.) Instead of “piecework” payments, and yearly negotiations over the Sustained Growth Rate, he proposes to pay for patients’ overall health status. He’ll get rid of cost disparities, like those in McAllen, Texas, detailed by Atul Gawande in a much quoted article in The New Yorker.
In return, he needs the doctors’ help. “The fact is, Americans—and I include myself, Michelle, and our kids in this—we just do what you tell us to do.”
Obama promised that “if you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.” Same for “your doctor.”
He did not promise, however, that the price would not become unaffordable because of new regulations, such as guaranteed issue or community rating, or that the plan would still be available. Or that the doctor would still be in practice.
Congressmen, including Charles Rangel (D-NY), say the “overhaul” will definitely cost more than $1 trillion. Sen Orrin Hatch (R-UT), estimates that costs will exceed $1.5 trillion. Legislation being drafted by House Democrats will include $600 billion in tax increases and $400 billion in cuts to Medicare and Medicaid.(Bloomberg.com 6/12/09).
Additional information:
- AAPS congressional briefing 4/16/09.
- AAPS on Fox News 6/11/09.
- Kennedy releases draft “health care reform” proposal. AAPS News of the Day 6/10/09.
- Baucus proposing Hillary-redux only worse; Coburn and others propose Republican plan. AAPS News of the Day 5/30/09.
- Follow AAPS on Twitter at www.twitter.com/aapsonline.
