During the past few days, organized medicine has lived up to its reputation as being anything but organized.
As reported by Jacob Goldstein in his Wall Street Journal health blog, several large physician membership organizations, have come out squarely "opposed" to the Senate bill. The opposition is being led by the American College of Surgeons and 19 surgical specialty societies. Goldstein characterizes the American Medical Association as taking a "middle ground" approach.
What is the basis given by the opposition physician groups? It is not over the big philosophical and ideological issues - like the debate over the "public plan" or the role of government or tax increases or deficits and debt. Instead, the surgeons' opposition is focused principally on issues of payment issues, and particularly, changes that could cause redistribution of dollars among and across physician specialties. Among the policies behind the surgeons' opposition, according to the ACS letter, are:
"Establishment and proposed implementation of an Independent Medicare Advisory Board whose recommendations could become law without congressional action;
- Mandatory participation in a seriously flawed Physician Quality Reporting Initiative (PQRI)program with penalties for non-participation;
- Budget-neutral bonus payments to primary care physicians and rural general surgeons."
(The latter has to do with a 10% increase in Medicare payments for designated services by primary care physicians, and for general surgeons in health professional shortage areas only, half of which would be funded by a one-half-of-one-percent decrease in payments for all other physician services.)
Today, the American College of Physicians sent its own letter to the Senate. Like the ACP has done throughout the legislative process, we determine our positions on the bills based on how closely they meet key ACP priorities and policies. ACP's letter noted that the Senate bill includes important and essential reforms that overall are consistent with ACP, citing provisions in the bill that would expand access to 94% of all legal U.S. residents, train more primary care physicians, reduce student debt for physicians who go into primary care, increase Medicare primary care payments, and accelerate the adoption of new payment and delivery models, like the Patient-Centered Medical Home. ACP also expressed "significant concerns" about other provisions. Some of ACP's concerns, like opposition to penalizing physicians with pay cuts for not reporting on quality measures, are similar to the concerns of the surgeons. But on other issues, like the independent Medicare Commission, ACP recommended ways to improve the provision by adding more safeguards, rather than coming out in opposition to the whole bill.
The surgeons have said that they support the House health reform bill, and that "While we must oppose the Patient Protection and Affordable Care Act as currently written, the surgical coalition is committed to the passage of meaningful and comprehensive health care reform that is in the best interest of our patients."
The problem, though, is that if physician opposition denies the bill the 60 votes needed to pass, it is "game over" for health care reform. Not just now, but for a very long time. Paul Krugman writes in the New York Times if the Senate bill fails "it would be a long time before anyone was willing to take on the challenge again; remember that after the failure of the Clinton effort, it was 16 years before the next try at health reform."
On the basic question of whether the country would be better or worse off if health reform fails, ACP's view is that the country will be better off if Congress passes legislation to provide affordable coverage to all Americans, expand the primary care workforce, and improve payment and delivery, even as we seek changes in positions we don't like. Opposition to the Senate bill by some physicians could kill health care reform, and with it, the best chance in a generation to put health care on a sustainable path.
Today's question: What is your view of the different approaches taken by physician groups to the Senate bill?