Monday, November 14, 2011

Doctors’ Rx for America: More government regulation*

*of everybody but physicians, that is

I blog today from the American Medical Association’s House of Delegates meeting in New Orleans, where the organization’s House of Delegates—its policy-making body—will soon take up dozens of reports and resolutions. Reading through the delegates’ handbook, I am struck by the seemingly counterintuitive fact that much of it calls for more government regulation of health care, even as the organization pledges fealty to free market principles. Plus, many of the demands for more government regulation are coming from some of the most conservative factions in the AMA—state medical societies from areas of the country shaded red.

To illustrate, the delegates will be considering policies to:

· Give the federal government the authority to negotiate drug and medical device prices.
· Require physician supervision of nurse practitioners.
· Prohibit investors from investing in medical malpractice lawsuits.
· Require automated external defibrillators in all nursing homes.
· Require states to appoint physicians to the governing boards of health exchanges.
· Mandate that all insurance companies pay for all current CPT codes billed by physicians beginning on January 1 of each year.
· Require insurance companies to pay no less than the Medicare rates for covered preventive services.
· Mandate that insurance companies raise payments for vaccinations.
· Prohibit health insurers from dropping physicians from their panels “without cause” during an enrollment year.
· Promote model state legislation to mandate that insurers use a “transparent and accountable” process in developing and implementing coverage decisions.
· Establish uniform prior authorization requirements for drug benefits.
· Require pharmaceutical manufacturers to report on drug shortages.
· Require hospital drug pharmacies to report outpatient controlled substance prescriptions to an appropriate regulatory tracking program.
· Require veterinarians’ prescriptions of controlled substances to be reported to regulatory authorities.
· Require FDA regulation of “potentially hazardous” energy drinks like Red Bull.
· Mandate nutrition labeling in school cafeterias.

Now, not all of these proposals will be approved by the House of Delegates, and to be sure, the delegates also will be considering numerous proposals to decrease regulation—of physicians, that is. And some of the calls for increased regulation are surely right on the mark.

But physicians, like the rest of us, are hardly internally consistent when it comes to their views on government regulation. No one really wants to be subjected to rules and mandates, so we fiercely object when someone tries to impose them on us. Yet, at the same time, we can usually find plenty of grounds to justify imposing regulations on someone else! We are against government, except when we are for it. Just ask the good doctors at the AMA.

Today’s question: Do you agree that physicians—and just about everyone else, for that matter—are internally inconsistent in being against government regulations that apply to themselves, but in favor of more government regulation when it comes to others?


Steve Lucas said...

We mere mortals are inconsistent, the AMA is not. Taken as a whole there is one over riding theme to all of these recommendations: Doctors, and by extension, the AMA should be in charge of all medical decisions in this country regardless of economic consequences.

“I am the great and powerful Oz!”

This comes from an organization that represents a small minority of practicing physicians, while at the same time collecting millions of dollars in fees from services to, and on behalf of, vendors.

Of interest may be this:

“Mandate that all insurance companies pay for all current CPT codes billed by physicians beginning on January 1 of each year.”

This becomes self serving since until recently, the AMA committee that set these codes, was kept from public view. There is a current legal suit concerning the AMA’s control of these codes and the AMA derives millions of dollars in revenue from the sale of these codes.

Mandating payment will only cement the AMA’s control over all payment systems in the US.

Such things as the Red Bull and veterinarian issues harkens to control of process where they feel they will have input and thus an opportunity for financial gain.

From my perspective the AMA is a grinding financial machine, well integrated into the DC establishment, whose only purpose is the continuation of the machine while extracting the maximum amount of financial gain from the government, vendors, and its own business ventures.

Steve Lucas

ryanjo said...

Received an email from my state medical association (FMA) today that the largest state medical associations (NY, Florida, Texas and California) are using the site of the AMA Delegates meeting to meet independently. The theme is to use their considerable success lobbying for physician priorities on the state level to work "parallel" to the flailing and misguided AMA nationally.

My hope is our local ACP chapters might pick up the same initiative. There is a contentious election ahead, and the contenders are hungry for money and targeted support. A sad comment on our political system, but ACP position papers are meaningless in this environment.

doc777 said...

The AMA does not represent most physicians. The last number I saw was that about 17% of active physicians were members. That number has been steadily decreasing. A physician with inside information told me that AMA membership in some states was hemorrhaging. If you also take into consideration that many physicians have their dues automatically paid by their employer, a more accurate percentage of practicing physicians who choose to be members is likely closer to 10%.

The AMA leadership at the national and state levels tends to be left of center, even in the "red" states. Our state house of delegates meeting is routinely flooded with resolutions from the activist left. Most get shot down but some do get through. The left will use every opportunity they have to push through their agenda even if it results in splitting the society in two.

Steve is also correct. The AMA does not even need their membership. A major portion of their income comes from their products. My understanding was that the Obama administration hinted that the AMA's exclusive control of the cpt codes might be at risk if they did not support the PPACA. They were also promised a permanent fix to the SGR formula. That last one obviously did not work out too well for them.

The fact is that physicians are divided on their views of health care and the role of government just like the general population. Those of us who believe the government needs to get the heck out of health care, do not waiver in our views. Unfortunately, we are kept out of leadership positions by the liberal elitists who run our professional societies. Instead of fighting the entrenched establishment, many who can, simply cancel their membership. I predict that as the health care system collapses, membership in some of the newer conservative medical professional societies will soar.