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  • But the evidence is right there – right there! – in front of you.

    Posted by onparkstreet on March 25th, 2010 (All posts by )

    (paraphrasing a conversation)

    Me: Hi, I’m calling about my AMA dues notice?
    AMA representative: Yes?
    Me: I’m not a member currently. I’d like to be removed from your mailing list, please. I don’t plan on becoming a member any time soon, so I don’t need the dues notices.
    AMA representative: Okay.

    ****

    From the AMA website a couple of days before the vote:Washington, D.C. – After careful review and consideration, the American Medical Association (AMA) today announced its qualified support for the current health reform bill as a step toward providing coverage to all Americans and improving our nation’s health system.”

    Also from the AMA website (where they have a counter “counting down” to the 21% Medicare Physician cuts with the admonition to “take action now”:)

    Resolving the problem now is the fiscally responsible course to take. Relying on past methods of postponing the immediate crisis will only increase the cost of a permanent repeal. Congress can no longer afford to kick the can down the road.”

    Does anyone want to explain the above statement to me? Seriously, I’m trying to understand what the organization might mean with that statement about fiscal responsibility – as they ask members to call and complain about cuts to physician medicare payments. What was that about CBO scoring again? I’m a dunce at all of this, so I ask for help from the readership! It’s a real question….

     

    8 Responses to “But the evidence is right there – right there! – in front of you.”

    1. methinks Says:

      I’ll give it a go….

      “We’re a large and powerful organization who is owed a lot of favours by politicians whom we supported to pass this idiocy…er…essential reform to a crumbling, third world medical system. Government now has all the power. Let the Rent Seeking begin!!”

    2. onparkstreet Says:

      Methinks, the whole thing is a complete mess.

      - Madhu

    3. Jonathan Says:

      Classic con game. Almost everyone who plays eventually gets screwed. Some of the players play because they think that they can gain an advantage by cooperating with the con artist against other players, or because they think that they can outsmart the con artist. In most cases they are wrong. The best strategy in the long run is probably to avoid playing.

    4. onparkstreet Says:

      Jonathan:

      Yes, that’s what I thought, too. I guess I don’t like the attitude being projected that the AMA represents physicians, and that the only way to improve health care is to argue about reimbursement rates. Physicians and hospitals are absolutely a part of the problem – a huge part of the problem. Looking inward does not seem to be a strength of our profession….

      - Madhu

    5. methinks Says:

      madhu,

      Where Rent seeking is the game, it usually results in a complete mess.

    6. Michael Kennedy Says:

      It was the AMA that cooperated (actually competed for the contract) with Harvard School of Public Health scholar Hsiao to develop the Resource Based Relative Value Scale. This innovation introduced the labor theory of value to the pricing of medical services. The actual intent, and the way it was sold to AMA members, was it devalued complex surgical procedures. The internal medicine societies supported it on the theory that the additional funds freed up by stiffing surgeons would be available to increase primary care payment. Of course, this turned out about like Obamacare is turning out. The insurance companies quickly followed Medicare’s lead on the fee schedule.

      I believe the real purpose was to discourage surgeons from the more difficult and complex procedures.

      Everybody lost out, of course, and the real costs of Medicare were not the rare complex surgery. A couple of years later, I was at a vascular surgery meeting where the medical director of the Ochsner Clinic made an announcement. Ochsner had the best results in the world on aneurysms of the aortic arch, an extremely difficult operation. Vascular and heart surgeons had been referring those cases they could to Ochsner and he said they had decided they would have to refuse referrals because the clinic lost $250,000 per case.

      The AMA began the trend to rationing. I should add that those aortic arch aneurysm cases were usually not in the elderly as surgeons would not recommend such a big operation in the aged.

    7. onparkstreet Says:

      Michael Kennedy: Physicians, and the hospital system, have a lot to do with the mess of health care. I guess as long as salaries were high and the times were good, there was no need to try and advocate for something better.

      And here, I am being unfair to my own profession. But I will say this: I think that the medical schools should introduce a more robust curriculum in certain areas – medical economics and all that. Are there schools that do such a thing?

      Finally, I remember, anecdotally and likely completely inaccurate, a faculty member telling me all about how the basic 88305 – charge for a biopsy – was decided on in pathology. A standard endometrial biopsy was decided to be the basic type of biopsy and it was argued that an expert would likely take less time performing an 88305 than a generalist pathologist. “Hey wait,” I remember saying, “but we specialists could take more time or less, depending on the type of problem we are being asked to solve and diagnose!”

      I’ll have to talk to the former collegue, again, and get the scoop on the real story.

      - Madhu

    8. onparkstreet Says:

      Also, I can’t help thinking about how our haphazard health care system has grown, and how it supports the idea that government often spends a good chunk of its time solving problems it initially created!

      - Madhu