President Barack Obamas visit to last weeks meeting of the American Medical Association House of Delegates in Chicago made a big splash, but whether the speech and follow-up from the physician group will have any significance on healthcare reform remains to be seen.
Obama visit makes news, but group’s role unsure
Delegates appeared more concerned than usual about the opinion of the media and the outside world, while also going to great pains to avoid tying the hands of their advocacy team negotiating healthcare reform in Washington. This resulted in the term public option being removed from a resolution that had been specifically about the presidents alternative insurance plan when it was originally introduced.
The president addressed the meeting on June 15 and tried to assure physicians that the intent of his public-option health plan was to stimulate competition that would force waste out of the system and keep the insurance companies honest, Obama said in an hourlong speech. The public option is not your enemy; it is your friend, I believe.
Obama was met with standing ovations more than a half-dozen times, with the loudest applause coming after he issued a call to do more to reward medical students who choose a career as a primary-care physician and to make changes so doctors are not constantly looking over their shoulders for fear of lawsuits, which leads them to order more tests and treatments to avoid being legally vulnerable.
In describing what he wanted to do, the president said that his plan would be guided by a simple principle: Fix whats broken and build on what works. Later, he specifically mentioned 452-bed Cincinnati Childrens Hospital Medical Center, 453-bed Tallahassee (Fla.) Memorial HealthCare, Geisinger Health System, Danville, Pa., and Intermountain Healthcare, Salt Lake City, as islands of excellence that have to be replicated elsewhere.
Obama endorsed reforming physician compensation so it rewards outcomes rather than volume, and one way to do that would be the use of bundled payments for the treatment of chronic conditions.
But not everyone agrees. It will be nearly impossible for his plan to work without destroying what currently works, and also without interfering with the physician-patient relationship, said John Black, president of the South Carolina Medical Association, in a written statement on the associations Web site.
Obamas speech followed days of debate about whether the AMA did or did not support a public option, raising the stakes on the AMAs annual get-together. How the brouhaha regarding the AMAs position on a public option will affect the groups ability to influence reform is an open question.
At least going into the meeting, the AMA had the attention of the White House. Outgoing AMA President Nancy Nielsen made a point of noting who came with the president to Chicago. According to Nielsen, Nancy-Ann DeParle, director of the White House Office of Health Reform; Peter Orszag, White House budget chief; and David Axelrod, senior adviser to the president, all had accompanied Obama. That is how important you are because you represent the doctors of the nation, Nielsen said.
Nielsen had spent much of the meeting and the time leading up to it trying to clarify the AMAs position on the public-option concept after reports came out that the organization opposed it. Those reports were wrong, Nielsen said, explaining that the AMA felt a public option was not the best way of achieving the goal of full coverage for the nation but this was not the same thing as saying we oppose.
While seeking to avoid using the term public option, Nielsen said that the AMA is open to discussing whatever options are in play and is committed to getting reform passed this year. With this goal in mind, the strategy was to not get hung up on the words public option, which had already become a loaded term and given such labels as government-run healthcare even though no one even knows what it would look like, she said.
The public option was debated first in committee on June 14, and then before the full House of Delegates the afternoon of June 16 and morning of June 17, with speakers often noting the importance of crafting the right message for politicians, the public and the media. For example, a delegate persuaded the House of Delegates to change healthcare financing to healthcare reform, so others wouldnt think that money was the AMAs driving concern.
Another time, a delegate from Minnesota said to be blunt, these words are understandable to the geniuses in the media.
Ultimately, delegates reached a consensus that the policy statement the AMA negotiating team will carry with them into healthcare reform discussions should read: Resolved, that our AMA (supports) health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice and universal access for patients. The words health system reform were inserted in the place from which the term public option had been deleted.
In addition to arguments against the public option, much was also made of how, after delegates applauded Obama for his comment on liability reform, moments later they booed the president because he noted that he still opposes capping malpractice awards.
Nielsen said she wasnt surprised when Obama mentioned his opposition to caps, because that has been his position all along. Instead, Nielsen said she was pleased with his apparent willingness to address the need for liability reform and added Obama is the first Democratic president to do so.
AMA Board member Robert Wah agreed with Nielsen on the significance of Obama bringing up the topic. There were no details, but its a start, Wah said immediately after the speech. Were hoping he doesnt lose that off his radar screen because its a very important part of health system reform.
OB/GYN Madelyn Butler, a delegate from Florida echoed Wahs statement. Its the details Im concerned about, Butler said. I deliver babies, so liability is a key.
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