Tuesday, September 8, 2009

The AMA does not represent physicians

We physicians should declare that the AMA does NOT speak for us – and that they have the spine of a jellyfish....

The AMA recently had a historic chance of opening their mouths very wide and getting their intentions known. They had the attention of the president and the media and the pundits – and for a brief moment everybody on the health care reform stage was waiting to see what "the doctors" think about Obama’s important reform project. If you negotiate with someone like the US president, you do not open the conversation by saying "We basically agree with you". In that instant, you have lost, you are dead, you are in his pocket and only a side note in the health care debate.

And the AMA blew it, they blew it so magnificently and so terribly that I cannot find words for it. It was horrible....

Here is what they should have said:

”Dear Mr President:
before we even begin to talk about reform,


1. MALPRACTICE REFORM – and we want it our way, for example with health courts or with “Patient’s comp”, an institution analog to Workman’s comp. This will be much more fair than the present lottery system. It will encourage systems reform, it will curb defensive medicine. And that will save the country and the health care system a bold 100-200 billion a year - just what you want.

2. we want GUARANTEED BALANCE BILLING – for all patients, anywhere, all the time. Just like the dentists. Because that is the only way to ensure our financial survival. Then your government can decide to pay peanuts for our work, and we will still be able to find a way to survive.

3. and then, still before we take a look at your bill, we demand COLLECTIVE
BARGAINING for physicians. This seems to run in counter of the previous demand, but it is for all those physicians that agree to accept whatever an insurance company or government decides to pay us for our work. It is the only way they can hold up against the massive pressure of these usually very large and very powerful entities that have been lowering payments to us consistently over the past 20 years.

WE WANT THIS, because WE ARE health care. We are the people who do the work, we are the people who have the knowledge, the skills and the experience. Nobody else has.

When you have allowed us to write the above three points into the bill, we will consider the rest of the bill. And don’t even try to insinuate that we do not have the best interest of patients in mind, that would be despicable rhetoric – we have work for them all day long, it is our dedication, our choice, our profession to have their best interest in mind!

And if you and your party do not agree to this we will say louder than you can imagine that we are opposed to your plans, and we will not cooperate, in no way. We will continue to trumpet this into the world, no matter what happens. And we are not only the heart and core of health care, we talk to patients, to everybody, every day, all day long”

Now, that would have been a message! Not a meek rearranging of priorities of the points in Obama’s reform list.

I am not blind enough to think that these demands will go through. But you have to bring them up, you have to shout them out, you have to stand up for your concerns and your needs! Only then can you pester the other side with "well, you did not agree to 1 nor to 2 nor to 3 etc....so now you have to....."

The AMA does not even know the 101 of negotiating. What the AMA did was to lower their heads and demurely convey "oh, our demands will not go anywhere anyway, we may just throw the towel right away". Predictably the president filed the AMA away as “done deal, they are on my side”. Check.

We should be- and we are - selfless and always place patients first when in the office. But in politics we also have a few needs of our own. Representing those needs requires more than the AMA can see, can muster, can wrap their minds and their inner strength around and definitely more than what they can do.

The AMA missed, again, a historic opportunity to represent the interests of physicians. If they represent anything at all, it is certainly not physicians…..

AMA, if you have NO GUTS - and NO STREET SMARTS - then you should at least have the decency not to pretend to "represent" physicians.

Go home, AMA! You are not representing me!

Tuesday, September 1, 2009

The Physician' s Appeal

The Physicians' Appeal, written by the The Sermo Team - of Sermo.com

To the American People,

We, the physicians of this country want to reform health care and improve the quality and access to care for our patients while reducing costs. True health care reform will only succeed if:

1. Unnecessary tests and procedures are reduced through tort and malpractice reform

2. Doctors are allowed to spend more time with their patients and less time on paperwork by streamlining billing and making pricing more transparent (create an alternative to CPT codes)

3. Medical decisions are made by physicians and their patients, not insurance company administrators

4. Adequate supply of qualified physicians is assured by revising the methods used to calculate reimbursements.

We invite policy makers to work directly with the men and women who are on the frontlines of health care each and every day caring for the citizens of this country.

We pledge to be partners in true health care reform, improving the health care delivery system in this country while honoring the Hippocratic oath that we all have taken.

Respectfully Yours,

America's Physicians.

A Few Words to Our Patients

This is a letter that I recently received from Dr. Cameron Schaeffer, pediatric urologist in Lexington, Kentucky. It stands out due to its clarity and creativity. I very much agree with him!

Begin quote:

We, the undersigned physicians of this community, are concerned that expansion of the role of the Government in our nation’s health care system will significantly harm our nation, our profession, and our ability to care for you. We fear that we are on a path well-traveled by other nations and with a destination so predictable that the journey need not be repeated. Despite its faults, America still has the best health care system in the world as evidence by the hundreds of thousands of people who flock to this country every year for training and care; for critics to claim otherwise for political gain and without scrutiny is unconscionable.

We adhere to the following:

Privacy: Third party involvement in the doctor patient relationship is a fundamental violation of patient privacy and our Hippocratic Oath. Personal health information of the most sensitive nature already resides in the vast databases of insurance companies and governmental agencies. A centerpiece of proposed Government health care reform is the expansion of these databases, which are NEVER secure. We do not want your most personal secrets to leave our offices without your explicit permission.

Freedom: This Nation and its economy were founded on the right of independent parties to contract freely for goods and services in a competitive market, and this includes doctors and patients. Free markets lower costs and improve services. Goods and services are exchanged based on price, and prices for health-related services should be negotiated in advance of illness by insurance companies on behalf of their clients or by patients contracting directly with doctors and hospitals. Government price schedules have no market basis and often do not adequately cover physician costs, which is why many doctors do not accept Medicare and Medicaid. For markets to function properly, people must understand what they are exchanging. Our health care system woefully lacks transparency in price, cost, reimbursement, and quality of the services provided at every level. Reforms should empower all parties in the health care economy to contract freely, intelligently, transparently, and in good faith. Your freedom to determine what happens to your body must not be abridged.

Cost: The costs of Medicare and Medicaid are already staggering and unsustainable, and the Congressional Budget Office has stated that additional programs will incur more debt. Our debts, mostly carried by foreign countries, must be paid by our children or by devaluing the dollar. This course threatens our economy and our future as a Nation. Our health care system is based on, and our tax laws promote, third party payment schemes which are inherently inflationary because the patient and his doctor are incentivized to consume. Until we are incentivized to shop wisely as individual consumers caring for our own bodies, the problem will continue. As long as third parties, i.e. the Government an insurance companies, are paying the bills, they are incentivized to limit and to ration care.

Insurance Reform: We need fundamental insurance reform in this country. We can start by making health insurance about insuring risk of serious injury or illness, not a prepayment scheme for every sniffle. We have auto insurance for accidents, not oil changes. New private risk pools for individuals and not-for-profit insurance companies would enhance competition, i.e. improve services and lower costs. If insurance companies are required to accept all applicants, including those with preexisting conditions, they will create larger risk pools to manage the risk. The Government should not be allowed to “compete” because it is impossible to compete against an entity that prints money, does not have to collect premiums, does not have wellness programs, and does not pay taxes. Patients should be allowed to purchase health insurance across state lines like everything else that is sold in this country, and it should be tax-deductible. They should buy it as individuals for life, like life insurance, which makes it guaranteed, portable, and not subject to preexisting conditions. Freed of the need to provide health insurance for employees, employers will pay higher wages to stay competitive in the labor marketplace. Insurance companies need to improve transparency in physician contracts and quit playing reimbursement games with doctors.

Caring for the Uninsured: The Government cannot make uninsured patients disappear by passing laws. They are a societal problem. To ask providers to shoulder most of the cost of caring for the uninsured is unfair. The Government should allow providers to deduct the cost of caring for the uninsured from their taxes, like any other act of charity. Rather than create new programs for the uninsured, the Government should create a mechanism to allow immediate enrollment of the uninsured in Medicaid at the point of service. The insurance status and personal financial liability of these patients can be evaluated retroactively by Medicaid.

Malpractice Reform: The cost of medical liability insurance for physicians is high, and the cost of defensive medicine is real and enormous. Ultimately, these costs are paid by all of us. The utter absence of any discussion of malpractice reform in Washington is a disgrace and fundamentally dishonest. We believe that patients should be compensated for economic damages caused by medical malpractice, but we also believe that our legal system is a circus of blackmail and jackpots, disconnected from true medical malpractice and true damages. Furthermore, and cruelly, it takes years for deserving patients to receive compensation, long after they most need it.

Regulatory Burden: Our regulatory burden is onerous both in time and money, and it frequently contributes nothing of material value to you, our patients. We need relief from this burden to better care for you. Any proposed reforms should diminish, not expand, this regulatory burden.

Personal Responsibility:
We all have a civic duty to buy health insurance, and those who cannot afford it should be subsidized, perhaps through taxes on unhealthy foods and non-essential purchases. Some people, particularly the young and healthy, choose not to buy health insurance, even when they can afford it. These individuals must be incentivized to buy health insurance to spread the risk.

Wellness: Under our current system, patients have almost no financial incentive to lead healthy lifestyles. Mechanisms to incentivize wellness could be created, and patients who take care of themselves should be rewarded with lower health insurance premiums.

We are professionals, not commodities. Our training required years of dedication, and it came at a great cost, personally and financially. The assets of the businessman reside in his building and its contents; ours reside in our heads and in our hands. They belong to us, not the insurance companies and not the Government. These assets have real value, and we passionately want to use them to heal you when you are sick, on mutually agreeable terms. Any attempt to force us to work for the Government, without our individual consent, is a form of theft, a corruption of our relationship with you, and an assault on our professionalism.

Stand with Us: Send this advertisement to your representatives and tell them that free market principles can work in health care, just as they do in other service industries. Demand that they fix Medicare, Medicaid, and every VA Hospital BEFORE creating any additional programs. Demand removal of distortions in the tax code that promote third party payment and thus health care inflation. Demand the expansion of tax-free medical savings accounts which empower you, the patient, to find good care at a good price. Demand policies that incentivize providers to discuss their results and disclose their pricing. Remind them that “health care” starts with individuals and that all Americans must be incentivized to stay healthy. Tell them that jackpot justice has no place in the compensation of patients who have been injured while receiving medical care, irrespective of the cause of injury. Stand for freedom, dignity, and respect for the individual citizen, and oppose any reforms that might imperil your right to determine what happens to your body.


Contact information for Kentucky Congressmen:

Email: www.webslingers.com/jhoffman/congress-email.html

Jim Bunning 316 Hart Senate OB Washington, DC 20510
Phone: 202/224-4343 Fax: 202/228-1373
Mitch McConnell 361-A Russell Senate OB Washington, DC 20510
Phone: 202/224-2541 Fax: 202/224-2499
Ed Whitfield 2411 Rayburn HOB Washington, DC 20515
Phone: 202/225-3115 Fax: 202/225-3547
Brett Guthrie 510 Cannon HOB Washington, DC 20515
Phone: 202/225-3501 Fax: 202/226-2019
John Yarmuth 435 Cannon HOB Washington, Dc 20515
Phone: 202/225-5401 Fax: 202/225-5776
Geoff Davis 1108 Longworth NOB Washington, DC 20515
Phone: 202/225-3465 Fax: 202/225-0003
Hal Rogers 2406 Rayburn HOB Washington, DC 20515
Phone: 202/225-4601 Fax: 202/225-0940
Ben Chandler 1504 Longworth HOB Washington, Dc 20515
Phone: 202/225-4706 Fax: 202/225-2122

This advertisement was wholly purchased by the physicians listed above, unconnected with any political party or interest group