In a letter to the American Society of Anesthesiologists (ASA), which like many medical organizations has expressed some reservations about reform bills “in their current form,” AAPS President Mark Kellen, M.D., of Rockford, Ill., writes: “The entire logic of H.R. 3200 is flawed and is based on decreasing patient choices and ultimately transferring control to the federal government…. The bill has no laudable parts.”
A coalition of some 17 state medical associations and three specialty societies discussed distancing itself from the AMA and opposing the inclusion of a public insurance option. The Medical Association of Georgia is “opposed to the creation of a public option under any circumstances,” said executive director David Cook (Congress Daily AM 7/16/09).
The American Society of General Surgeons (ASGS) issued a statement opposing certain features of the public option: the use of the Medicare reimbursement system, and the automatic enrollment of surgeons who participate in Medicare.
So far, none other than AAPS has issued a statement of unqualified opposition, and physicians are threatening to resign from societies that endorse the bill or offer only tepid objections.
“This is war,” said George Watson, D.O., of Wichita, Kan., President-elect of AAPS. “This is a bureaucratic boondoggle to grab control of health care. Everything that has been proposed in the 1,018 page bill will contribute to the ruination of medicine” (FOXNews.com 7/22/09). The bill is loaded with rules and regulations that will result in shoddy care and long waiting lines, he added. The provision to force doctors contracted with Medicare into the nationalized plan is a “trap” that he called “involuntary servitude.”
Announcing her resignation from the AMA, Elizabeth Lee Vliet, M.D., of Tucson, Ariz., also an AAPS member, said: “The AMA is not representing patients or doctors anymore.” She noted that 85% of AMA revenue comes from business interests such as CPT codes, not membership dues (ibid.).
Public opposition is rising as Americans learn about what is in the bill. Despite the efforts of left-wing community organizers to mobilize support, calls to Congress are reportedly running 15 to 1 against the bill, according to Greg Scandlen (Consumer Power Report #187, Jul 24, 2009).
Some of the non-laudable features coming to light are:
- Mandatory “end-of-life counseling” for seniors, at least every 5 years. This amounts to an attempt to convince seniors to die, according to former New York Lieutenant Governor Betsy McCaughey. A “quality reporting initiative” will measure creation of and adherence to “orders for life-sustaining treatment” such as “artificially provided nutrition and hydration” (WorldNetDaily 7/23/09). Further evidence of the assault on seniors is White House budget chief Peter Orszag’s urging Congress to delegate its Medicare oversight authority to an executive agency, thus dodging accountability (Wall St J 7/23/09). “Reform” amounts to a “repeal of Medicare as we know it,” write Dick Morris and Eileen McGann. The elderly will go from being the group with the best access to care to the one with least access (Newsmax.com 7/9/09).
- Repeal of ERISA. About 75% of employer-provided insurance is now governed by “freedom to purchase” rules under the Employee Retirement Income Security Act (ERISA). This keeps costs down by allowing businesses to avoid many costly state regulations. After a 5-year grace period, all plans would be subjected to “bureaucratic nanomanagement”—and also opened to lawsuits over employee benefits now barred by ERISA. This is one major reason why the Wall Street Journal, in its lead July 21 editorial, calls H.R. 3200 “one of the worst pieces of legislation ever introduced in Congress.
- Reckless experimentation on the economy. While the President claims that his health care reform is necessary to save us from a health-care system that is “breaking America’s families, breaking America’s businesses, and breaking the economy,” Orszag and congressional staff are flipping through the tax code looking for new sources of revenue (Wall St J 7/24/09). A Congressional Budget Office (CBO) chart shows stepwise increases in revenue ($50 billion, as from taxes on businesses and uninsured individuals, by 2020) and far larger deepening of the deficit (by $250 billion in 2020) (Wall St J 7/21/09). Even Orszag’s proposal for a Medicare-cutting agency would actually save almost no money over 10 years, according to the CBO (Politico 7/25/09).
- Disappearing ink, invisible ink. Nobody knows what will really be in the bill that Obama wants people to rush to support. It’s hard to rally public support, said Pharmaceutical Care Management Association president Mark Merritt, “around policy that doesn’t exist yet.” People have heard about reform aspirations, but not what reform will look like, or who will pay for it (Politico 7/24/09).
- A monstrous, ugly bureaucracy. A chart prepared by Rep. Kevin Brady (R-TX) of the proposed structure for controlling medicine is so monstrous that Republicans are forbidden to use the franking privilege to send it to their constituents. If Congress doesn’t really mean for bureaucrats to be in control, why was John Shadegg’s proposed amendment voted down? The amendment reads: “Nothing in this section shall be construed to allow any federal employee or political employee to dictate how a medical provider practices medicine.”.
- Equal pay for unequal qualifications. Section 1304 would raise Medicare and Medicaid payment to certified nurse midwives to the same level that obstetricians receive for procedures coded the same (CNS News.com 7/23/09). The midwives’ fee is currently only 65% as high. H.R. 3200 not only allows nurse practitioners to lead a medical home, but it changes the very definition of “physician”: on p. 445, the bill states: “(C) PHYSICIAN- the term ‘physician’ includes, except as the Secretary may otherwise provide, any individual who furnishes services for which payment may be made as physicians services.” The bill repeals the definition of “physician” in the Social Security Act, which states: “The term physician when used in connection with the performance of any function or action means (a) a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he performs such function or action.”
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