AMA backs Obamacare individual mandate

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une 20, 2011 11:00 PM
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AMA backs hot-button health insurance mandate

The nation's largest physician's group has affirmed its support for a key part of President Obama's health care overhaul.

At its annual meeting in Chicago, the American Medical Association (AMA) voted to maintain its official position in favor of the "individual mandate," which requires nearly all Americans to purchase health insurance. The AMA prefers the term "individual responsibility."

"The AMA has strong policy in support of covering the uninsured, and we have renewed our commitment to achieving this through individual responsibility for health insurance with assistance for those who need it," Dr. Cecil Wilson, president of the AMA, said in a statement. "The AMA's policy supporting individual responsibility has bipartisan roots, helps Americans get the care they need when they need it and ends cost shifting from those who are uninsured to those who are insured."

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The decision was made by some 500 members of the House of Delegates, which sets policy for the AMA. The vote followed intense discussions, according to delegates who took part.

"It was very emotional and it was very heated," said Dr. Bruce Malone, president of the Texas Medical Association, which opposes the mandate. "These are a large number of very intelligent people who can certainly have a democratic debate, and they did."

"I think it was very civil and I think very thoughtful," said Dr. Roland Goertz, president of the American Academy of Family Physicians, which supports the AMA position.

The individual mandate is the most controversial element of the Affordable Care Act, which became law last year but is now facing numerous legal challenges. In the most high profile case, now before the 11th Circuit Court of Appeals in Atlanta, the law is being challenged by Republican governors and attorneys general from more than two dozen states.

Malone said he is disappointed by the outcome of the vote and worries that the lack of consensus on the mandate will weaken the AMA. "Some people who strongly support the idea of 'no mandate' may drop their membership with the American Medical Association," he said.

This debate over the past two years has coincided with about a 5 percent decline in membership in the AMA, though it's not clear if support for the mandate is the reason 12,000 members quit the organization.

The outcome of the vote is an affirmation of the influence within the AMA of primary care physicians, who tend to support the mandate, over specialists, who tend to oppose it, according to Heritage Foundation health care expert Edmund Haislmaier.

Now, however, that view is not universally held.

"I do not think this is a family practice versus specialty issue," said Malone. "This is an issue of broad diversity in the 'house of medicine.'"

Goertz, a family physician in Waco, Texas, said the outcome in favor of the mandate is the right one.

"This has been debated so extensively, from every view point," he said. "If health care is going to be an important issue for Americans and the proof and the evidence shows coverage means better access, means better health decisions and better health for the public, that's what's driven our position."
http://www.cbsnews.com/8301-503544_162-20072800-503544.html#ixzz1Pw4vrhFJ
 

Neon

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Gee, doctors want to force everyone to get healthcare so that they never miss a payment? I'm shocked.
 

ShiftyMH

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Wow what a huge surprise. Just as surprising as car salesmen wanting to force everyone into buying a car.
 

Don the Radio Guy

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To be specific, it's like less than 20% of car salesmen trying to force people to buy cars. The AMA speaks for doctors as much as the UAW speaks for "workers".
 

Begbie

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Speaking of that great, well-thought out healthcare legislation...

A Twist In Obama's Healthcare Law
WASHINGTON – President Barack Obama's health care law would let several million middle-class people get nearly free insurance meant for the poor, a twist government number crunchers say they discovered only after the complex bill was signed.

The change would affect early retirees: A married couple could have an annual income of about $64,000 and still get Medicaid, said officials who make long-range cost estimates for the Health and Human Services department.

Up to 3 million more people could qualify for Medicaid in 2014 as a result of the anomaly. That's because, in a major change from today, most of their Social Security benefits would no longer be counted as income for determining eligibility. It might be compared to allowing middle-class people to qualify for food stamps.

Medicare chief actuary Richard Foster says the situation keeps him up at night.

"I don't generally comment on the pros or cons of policy, but that just doesn't make sense," Foster said during a question-and-answer session at a recent professional society meeting.
How could lawmakers and analysts have actually caught that glitch though...I mean, there were alot of pages in that bill that they would've had to thumb through. Honest mistake.
 

VMS

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I'm going to keep saying this: none of us wants affordable health insurance. We want affordable healthcare. The "healthcare bill" isn't a healthcare bill: it's a health insurance bill.

Basic supply and demand economics: by placing a secondary product (health insurance) between the consumer and the primary product they desire (healthcare), you shield the primary product from the effects of supply and demand. Therefore, healthcare gets more expensive. That makes health insurance more expensive, but then people demand that health insurance get cheaper, not the healthcare itself.

There's a reason why breast implant surgery and LASIK eye surgery have both gone down in cost while getting better. Health insurance doesn't cover it.

I'm not saying we should be ditching the health insurance system: I'm saying we're "fixing" things from the wrong end of the horse.

That, and the "healthcare bill" is still a sterling example of what happens when the President abrogates all responsibility for actually writing his own laws to Congress.
 

Hoffman

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I'm not saying we should be ditching the health insurance system: I'm saying we're "fixing" things from the wrong end of the horse.
Absolutely, and anybody saying the health system doesn't need to be fixed is frankly an idiot. The easier, and better solution to the problem would have been the creation of Health Insurance Co-Ops. The biggest problem with insurance these days is the companies could give a fuck about their customers, and for the most part there's no way around that for the customer. make the companies truly accountable to their customers though and we have a whole different story.
 
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I'm going to keep saying this: none of us wants affordable health insurance. We want affordable healthcare. The "healthcare bill" isn't a healthcare bill: it's a health insurance bill.

Basic supply and demand economics: by placing a secondary product (health insurance) between the consumer and the primary product they desire (healthcare), you shield the primary product from the effects of supply and demand. Therefore, healthcare gets more expensive. That makes health insurance more expensive, but then people demand that health insurance get cheaper, not the healthcare itself.

There's a reason why breast implant surgery and LASIK eye surgery have both gone down in cost while getting better. Health insurance doesn't cover it.

I'm not saying we should be ditching the health insurance system: I'm saying we're "fixing" things from the wrong end of the horse.

That, and the "healthcare bill" is still a sterling example of what happens when the President abrogates all responsibility for actually writing his own laws to Congress.
It's also why you can get brake jobs and oil changes for $20-$100 a pop, but you go to a body shop and it's $5k to roll out some dents. Same with basic home repairs vs a new roof because of hail or wind damage.

I don't get how people don't get this shit with all of the examples we have all around us.
 

Don the Radio Guy

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I don't get how people don't get this shit with all of the examples we have all around us.
Because they've grown up never having to pay for a doctor's visit. That ever increasing chunk just gets taken from their check every week, and they think they're getting something for free. Just like taxes.
 

VMS

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It's also why you can get brake jobs and oil changes for $20-$100 a pop, but you go to a body shop and it's $5k to roll out some dents. Same with basic home repairs vs a new roof because of hail or wind damage.

I don't get how people don't get this shit with all of the examples we have all around us.
I don't think anyone disagrees with this. But how do you incentivize regular checkups?

We can think of a hundred ways, of course, but the truth is that making a system that actually works in incentivizing regular checkups and good health practices is difficult, at best. Part of it is making people pay for their mistakes. It's not "nice", but it's how to make people actually behave better in the most minimally invasive way.

Not that people see it that way.
 
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Because they've grown up never having to pay for a doctor's visit. That ever increasing chunk just gets taken from their check every week, and they think they're getting something for free. Just like taxes.
You know, being self-employed most of my adult life I've never thought about it like that.
 

Party Rooster

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The easier, and better solution to the problem would have been the creation of Health Insurance Co-Ops. The biggest problem with insurance these days is the companies could give a fuck about their customers, and for the most part there's no way around that for the customer.
I don't think anyone disagrees with this. But how do you incentivize regular checkups?

We can think of a hundred ways, of course, but the truth is that making a system that actually works in incentivizing regular checkups and good health practices is difficult, at best.
Fucking communists.











:action-sm
 

MayrMeninoCrash

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#15
Gee, doctors want to force everyone to get healthcare so that they never miss a payment? I'm shocked.
Why shouldn't doctors expect to receive payment for services rendered?

Because they've grown up never having to pay for a doctor's visit. That ever increasing chunk just gets taken from their check every week, and they think they're getting something for free. Just like taxes.
I have some pretty good health insurance (that costs me $100 a week) and it still costs $20 to see a doctor and at least $15 to fill a prescription. I'm pretty sure I can't remember when a doctor's visit was "free".
 

Don the Radio Guy

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I have some pretty good health insurance (that costs me $100 a week) and it still costs $20 to see a doctor and at least $15 to fill a prescription. I'm pretty sure I can't remember when a doctor's visit was "free".
Do you honestly think it costs a medical office $120 (or whatever uninsured/self-insured people pay) to talk to you for 5 minutes and write you a Rx for Valium? Anything that is mostly subsidized by insurance is artificially price inflated.
 

MayrMeninoCrash

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Do you honestly think it costs a medical office $120 (or whatever uninsured/self-insured people pay) to talk to you for 5 minutes and write you a Rx for Valium? Anything that is mostly subsidized by insurance is artificially price inflated.
More importantly, do I care? It sucks to pay $120 to be told you have the sniffles, but when I have bones sticking out of my skin, I'm glad the doctor is standing by to stitch me up and not toss me in the gutter for the same $120.
 

TheDrip

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Because they've grown up never having to pay for a doctor's visit. That ever increasing chunk just gets taken from their check every week, and they think they're getting something for free. Just like taxes.
Nail on the head. The docs I work with have very little love for the AMA.
 

Neon

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Why shouldn't doctors expect to receive payment for services rendered?
They absolutely should be, and therefore their support of Obamacare should been seen as financial, not medical or ethical. Don't sell me some crap about "individual responsibility." You want to get paid with less red tape. Good for you.
 

MayrMeninoCrash

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They absolutely should be, and therefore their support of Obamacare should been seen as financial, not medical or ethical. Don't sell me some crap about "individual responsibility." You want to get paid with less red tape. Good for you.
Isn't it responsible to have a means to pay for your incurred medical expenses?
 

whiskeyguy

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...individual mandate," which requires nearly all Americans to purchase health insurance. The AMA prefers the term "individual responsibility."
Can you "mandate" responsibility? This seems like a pretty fucking weird sentence to me. "I'm taking responsibility for my life because I'm required to by law".

Anyway, it's fucking simple. As stated before, this bill did nothing to address the cost of health care, it just fucked with who pays for it. Address the core costs of health care and the financial burden on everyone will be reduced.
 

Southpaw

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There's a reason why breast implant surgery and LASIK eye surgery have both gone down in cost while getting better. Health insurance doesn't cover it.
Those are also examples of procedures that aren't necessary to maintain the health of the individuals who choose them, so the consumer has the ability to shop around for the best deal. In that way they are goods more like flat screens than they are like heart bypass procedures. There are other reasons why the competetive market model doesn't work for health care, as economists have known at least since Kenneth Arrow's work almost 50 years ago.

Here is a decent explanation in plain english of the issues:

1. Health care is generally not a refusable or elective service.

By this, I mean that in most cases, the health care costs are driven by medically necessary procedures. You get pneumonia. Your knees wear out. You find a lump in your breast. You notice blood in your stool. Barring the denial/self-neglect approach that some people take, when you develop a medical problem, you need to spend money to remedy it. While the timing of your knee replacement may be elective, whether to do it or not generally is not, if the alternative is being disabled and non-ambulatory. It is an inelastic demand, like the demand for gas. When gas gets more expensive, you still have to fuel your car, and except for very small variations, the demand for gas does not vary with the price. Similarly, the demand for medically needed care is not going to be terribly price responsive. When your doctor tells you that you need chemotherapy, you don't make the decision to proceed based on the cost, but on the need. And the number of recreational colonoscopies performed is actually very low.

It is true that some medical costs are elective and price sensitive -- preventative care, luxury procedures like Lasik, some office visits. These, however are a tiny fraction of overall health care costs. As in my analogy, some people do drive less when the price of gas goes up -- they take the bus instead -- but this does not reduce demand enough to make a difference in the price of oil.

2. There is an asymmetry of information

This asymmetry relates to both price and necessity. When your orthopedist tells you that your knee pain is due to a degenerated meniscus and that the best treatment for that is athroscopy, most consumers are going to simply accept the surgeon's advice. Now, as it happens, there is good evidence that arthroscopy of the knee provides no more benefit than placebo, but 99% of patients are not going to be aware of this and are not going to bother to do the research to find it out. Those that do, might find that the surgeon has an explanation why, in your case, he thinks it will be helpful despite the studies showing otherwise for other people. In most cases, the patient must trust the physician to provide accurate information on what is really needed. And if you should ask your surgeon what the cost of the arthroscopy will be, the answer will probably be "I don't know." Price transparency is poor to begin with but there is the very real fact that based on a patient's individual payer status the cost will vary dramatically, and the surgeon probably does not know what the cost will be for your case. Finally, when consumers make health care providers compete against one another to decide by whom and where the care will be given, they tend to be concerned primarily with quality and with cost as, at best, a secondary concern.

All these factors greatly inhibit competition and the development of a free market. To some degree it is possible to mitigate these, through, say, all-payer price setting, and mandatory disclosures and publishing outcomes data, etc. However, the third variable, in my opinion, makes the rest all-but-moot.

3. Purchasing power is concentrated in the hands of a very small number of "consumers"

This is the wooden stake through the heart of the idea that consumer behavior can effect cost containment. The functioning of a free market is dependent on the ability of consumers to vary their behavior to force suppliers to compete. However, you and I can be as scrupulous and cost conscious as we like. We are not sick. (Well, I'm not anyway. I hope you're OK.) The driver of cost is the small fraction of people who have serious medical conditions. It's the old 80/20 rule writ large...HALF of all health care costs in the US is concentrated in only 5% of the population, and 80% of costs are accounted for by the top quintile! (source: Kaiser Foundation PDF)

So the effect here is that with such a concentration of costs in such a small segment of the population, the ability of the larger population to move the market is highly restricted. You can make 80% of consumers highly price sensitive, but they can only affect a tiny fraction of healthcare spending. And for the generally well, their costs are probably those which are least responsible for the spiraling inflation. They're not getting $30,000 stents or prolonged ICU stays, or needing complex chronic disease management.

Conversely, those who are high consumers of health care simply cannot be made more price sensitive, since their costs are probably well beyond what they could pay in any event, and for most are well beyond the limits of even a catastrophic health insurance policy. Once you are told that you need a bypass/chemo/stent/dialysis/NICU etc, etc, etc, the costs are so overwhelming that a consumer cannot possibly pay them out of pocket. Since, by definition, these catastrophic costs are paid by some form of insurance, the consumer cannot have much financial interest in cost containment. For most, when they are confronted with a major or life-threatening illness, their entire focus shifts to survival, and they could care less about the cost. Further, many who are in this sick/expensive category have some diminished capacity with regard to their information gathering and decision-making. I'm thinking particularly of the elderly and those who have had strokes or any one of a multitude of illnesses which impact cognitive function or other functional capacity. These patients struggle with their activities of daily living -- getting dressed, bathing, transportation, housing, taking their meds. Their ability (let alone interest) in price-shopping their doctors is minimal to nonexistent, even if they had an economic incentive to do so. Taking someone who has a serious illness and making them have more "skin in the game" would represent a cruel additional hardship, but would be ineffective in creating an economic environment in which consumer behavior brought down spiraling health care costs.
And to make the abstract concrete:

On a personal note, I've recently acquired some experience with the perspective of someone who is a member of the 1% club. As I have blogged, my wife is under treatment for stage IIb breast cancer. We are pretty highly functional and informed consumers, and we actually have the financial resources to pay for more of our care than most would, so if, hypothetically, we had a stronger incentive to seek out more cost effective care we would be in a position to do so.

So, in our case, would we? No, of course not. My wife's chemo is going to cost >$100,000. I am sure that we could cut down the cost. Herceptin is pretty expensive -- are there less expensive alternatives? Turns out there are not. We spent a lot of money on Neulasta to keep her immune system operational during the intense chemo. Maybe we could have gone without it and just risked neutropenia? Maybe saved some money and used neupogen instead? That would have been quite a risk at minimal savings. Maybe we could have skipped the expensive anti-nausea meds? Not a chance! Chemo is miserable enough that those meds were worth every penny. (not to mention that all these meds might actually be cost-saving in keeping her out of the hospital with complications of chemo.)

What other options do we have in deciding how we treat the cancer? Radiation is non-negotiable, but maybe we could shop between facilities for the best deal. Of course there may not be much price flexibility on radiotherapy given the huge capital costs required. We will be interviewing half a dozen surgeons to determine who will do the mastectomy and reconstruction, and we are 100% focused on quality in making that choice.

So, in the end, if we had the proverbial "skin in the game" in making treatment decisions for my wife's cancer, I doubt it would make one iota of difference in the actual cost, or at very best only a small marginal difference in a very very expensive course of treatment. Bear in mind, we are the perfect test case! I can afford to pay $20,000 or more out of pocket if I need to, and it STILL wouldn't make a difference. If families with more limited means were obligated to pay the same $10-20K, if would mean financial ruin, or inability to access the lifesaving care, but it wouldn't allow the invisible hand to guide the market towards cheaper, more efficient care.

This is, ultimately, why people who believe that passing along the cost of health care to consumers will promote cost savings are wrong, and health reforms which are predicated on this concept will not work.
 

Don the Radio Guy

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Before the server backup, I had a long winded response to this. I'll tl;dr it down to this point: Demand for healthcare is elastic when it's offered in a market that isn't artificially inflated by insurance. When people have to pay for their own care, they'll stop going to the doctor for hangnails and common colds.
 

Southpaw

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Before the server backup, I had a long winded response to this. I'll tl;dr it down to this point: Demand for healthcare is elastic when it's offered in a market that isn't artificially inflated by insurance. When people have to pay for their own care, they'll stop going to the doctor for hangnails and common colds.
It's not hangnails and colds that are driving up health care costs, the big ticket items come from treatment of the sickest 20% of the population. Their demand is not elastic and unless the sickest 20% also happens to be the wealthiest 20%, there will need to be some form of insurance in the equation because even in free market fantasy land many treatments will likely be too expensive for most to pay out of pocket. Sure, some prices may come down if you reduce demand by cutting out insurance, but "reduced demand" in that context is a euphemism for sick people unable to afford treatment.

If you really eliminate insurance risk pooling, which in essence is the healthy 80% subsidizing the cost of treating the sick 20%, some treatments that were profitable to produce under an insurance-supported market might no longer be profitable when only a fraction of that former customer base has the individual means to pay for it.

Then there is the issue of sticky prices. While we wait the months or years it would take incredibly sick people newly "free to choose" what they can afford to pay out of pocket to move the market through competition, many prices will be resistant to downward movement even with a decrease in demand due to factors like long term contacts firms have with suppliers, executive pay packages, etc. Not sure what the free market solution is for sick people waiting for the invisible hand to make their treatment affordable.