Tuesday, August 3, 2010

Is the American Medical Association (AMA) in Obama’s Back Pocket?

By Alieta Eck, MD

In the recent AMNews, June 7, 2010, pp 6-7, we physicians were given talking points on how to tell our patients about ObamaCare. It was so full of "happy-speak" that one must wonder if the AMA has paid lobbyists for the Administration.

A typical question might be, "What's in it for me?" We are to say "For many patients who don't have coverage and can't afford it, the government in 2014 will offer sliding scale credits to buy a plan... Employers also are going to be expected to step up to the plate, offering coverage or kicking in part of the premium for employees who sign up for plans through the insurance exchanges."

Of course, that is assuming that our patients still have jobs. But we must not say that.

Our patients might ask, "Are Medicare or Medicaid going to help more?" Our answer is to be "Medicaid will undergo a major expansion. ...the federal government will be footing the bill for most of the expansion, but states will be required to help pay for it, provided a lawsuit by several states challenging the Medicaid piece does not invalidate it."

We probably should leave out the fact that most physicians cannot afford to see Medicaid patients at the current reimbursement rates, as we ought to present a positive front.

"Will there be enough doctors to see everyone?" The short answer is "No." But The AMA suggests we tell them that "The federal government will commit more money toward primary care training, redistribute unused medical education slots to primary care and general surgery, and commit more funding toward incentives for primary care doctors to work in critical care areas."

Never mind that the federal and state governments are already bankrupt.

Here's a great line. We can tell them that "innovative care delivery models and measures aimed at boosting health quality and efficiency are part of the reform law's plan to maximize the power of the existing physician work force."

Of course, that might be difficult as 40% of physicians, so demoralized by the specter ObamaCare, will be retiring or looking for other ways to earn a living.

"How might our plan of care change?" Here is where real doublespeak needs to be applied. The AMNews tells us to say that “coverage expansion should improve access to preventive care, allowing physicians to order relative fewer complex services and hospitalize fewer patients.

Effective in 2014, insurers will be required to cover a certain set of basic services, meaning that doctors and patients might not need to find as many alternatives to care that otherwise would be deemed too costly."

We must not suggest that the government might deem cheaper and less care to be the "best," as we must always assume that the bureaucrats in Washington really care about us.

Above all, we must reassure our patients that the government will be efficient, competent and careful in the way our collective health care money is spent. We can always point to the efficient speed with which the government has handled the oil spill in the Gulf.

The most important question of all might be "Will you keep me as a patient?" This answer as given by the AMNews was the most honest. They say, "Nothing in the reform law requires a physician to continue seeing existing patients or to take new ones through insurance exchanges, though many say they will as long as their practices can afford to provide the care."

As a physician in private practice, I will be happy to answer this myself. I can say that I have no intention of participating in any health plan and thus I will provide care without having to consider a bureaucrat looking over my shoulder. As stated in the Oath of Hippocrates, I will "follow the system of regimen which, according to my ability and judgment, I consider for the benefit of my patients."

I will also tell them that as long as we can keep any third party out of most encounters, I will be able to keep their medical records private. If my patients are willing to pay a fair price for my service, I will remain willing to provide that care.