The council, however, withdrew the report before the meeting started saying it needed more time to work on it. This prompted the Louisiana delegation to introduce a resolution with similar recommendations. Because it was introduced less than 30 days before the meeting, the resolution had to be reviewed by the AMA Rules and Credentials Committee on Saturday to be considered and then get approval the next day by two-thirds of the delegates to be put on the agenda.
Dr. Jeff White of Shreveport, La., introduced the resolution before the committee on Sunday and noted the need to “bring bold changes,” but he also offered an addition to the measure stating that Medicare beneficiaries should be offered the choice to remain in the current system if they wanted.
The chairman of the Council on Medical Services, Dr. Thomas Sullivan of Massachusetts, spoke next and noted that, months ago, the panel solicited feedback on the issue and received very little until just before the meeting. He added that defined contributions for Medicare and offering beneficiaries choices of health plans have been AMA policy since 2003 and 2007.
Sullivan also said that the terms “defined contributions” and “premium support” had only become highly politicized in the last year and a half.
Another council member, Dr. Robert Hertzka of California, noted that Medicare's viability continues to be threatened by so many forces that it has become something of a “sword of Damocles program” and the report's recommendations offered an opportunity for stability. He also pledged that the revised report would be ready to be voted on at the AMA House of Delegates interim meeting scheduled for November 8-10 in Honolulu.
Another delegate, however, noted later that it might be better for public relations if the AMA endorsed changing Medicare in Chicago rather than Hawaii.
Delegate Dr. Jeff Terry of Alabama commented that “These may not be the most politically correct policies, but they are medically correct.”
Dr. Glen Stream, president of the American Academy of Family Physicians, noted the timing, and said making such an endorsement during an election year may be construed as a political endorsement.
Dr. Daniel Johnson of Louisiana, the AMA's 1996-1997 president, said Medicare choice has been AMA policy since 1995. Dr. Nancy Nielsen of New York, the AMA's 2008-2009 president said the policy grew out of the Clinton administration's failure to enact healthcare reform. She also said ominously that, if the AMA promotes changing Medicare to a premium-support system, “you will find out what seniors think of that action.”
Dr. Joseph Hayman of Massachusetts, who was 2008-2009 chairman of the AMA board of trustees, said he was looking for evidence that premium support would work as proposed. And Dr. Michael Kitchell of Iowa compared the mystery of premium support to the unknown consequences of joining an accountable care organization.
“People say ACOs are like unicorns,” Kitchell said. “I believe this proposal is like Bigfoot.”
