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!

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