Saturday, June 20, 2009

Memo to President Obama: Look beyond the AMA!

Today, in article, Robert Reich gave some advice to President Obama on how to achieve universal health care despite the cost concerns that came up this week: make health reform a priority, utilize your popular support and don't compromise! He identifies allies (the 76% of Americans who support a public health insurance option) and opponents (Republicans, the medical-industrial complex, the AMA). And while I certainly support the approach of protecting your allies with a strong plan instead of watering things down to appease opponents, here is my advice to President Obama: you could find much more support for what you do want to do among physicians, if you were to look beyond the AMA.

The AMA does not speak for all physicians. As a medical student, I was active in the AMA but became frustrated with the disconnect between their mission ("to promote the art and science of medicine and the betterment of public health") and what I perceived to be their primary lobbying objective (advocating for higher reimbursement rates for physicians).

The membership in the AMA is declining, and now includes no more than 25% of physicians. In the current debate about the government’s role in health reform, the AMA has opposed a public health insurance option, but again, the organization does not represent my opinion, and likely does not represent the majority of physicians.

A study by Aaron Carroll and Ronald Ackerman, published in the Annals of Internal Medicine in April 2008, demonstrated strong support for universal health care among a random sample of over 2000 physicians (including all specialties). When asked the question, "In principle, do you support or oppose government legislation to establish national health insurance?" 59% of physicians responded that they supported national health insurance while only 32% opposed. This was a 10% increase from a similar survey conducted 5 years earlier. Now, two years later (the survey was conducted in 2007), I am certain the support has increased further. Physicians are not afraid of government involvement in health care financing.

In the past week, attention has turned to the health reform bills coming out of Congress, and the National Physicians Alliance, the American Academy of Family Physicians, and a coalition representing over 215,000 physicians and medical students released a public statement in support of the President and in support of a strong public health insurance option.

“As doctors who work on the front lines of our fractured healthcare system, we are convinced by firsthand experience that our patients desperately need health care reform that protects them from falling through the cracks. This means reform that creates the freedom of choice to keep their current plan, choose another private plan, or have the choice of a carefully designed quality, affordable public health insurance plan.”

While the AMA differs in their approach to health care reform, President Obama has much support within the physician community. As a doctor, it is troubling to me that I take care of extremely sick patients in the hospital but do not know where they will get their follow up care, or how they will pay for their medications, if they are uninsured or underinsured. As a medical educator, it is frustrating to me to waste time teaching medical residents how to fill out paper work and interact with insurance companies when we should be discussing clinical decision making and evidence based medicine. As an American, it angers me that so many other countries have similar (or better) medical care without the hassle or expense of our system. There are thousands of doctors like me who want to provide all of their patients with high quality care regardless of insurance status but just can't do so in the current system.

So, President Obama, be bold and demand universal coverage, including a public health insurance option. There are plenty of doctors who have your back.

Aaron Fox, MD

National Physicians Alliance

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