AMA presses plan to reform health care
October 23, 2008
By Mark Taylor Post-Tribune correspondent
The American Medical Association submitted its health plan proposal more than one year ago, part of a three-year, multimillion dollar campaign by organized medicine to reform a $2 trillion health care system whose increasingly high costs are making it unaffordable and inaccessible to many Americans.
But as the presidential election approaches, the 241,000-member AMA hopes the candidates and Congress will hear its plan. Speaking before the Chicago Association for Business Economics Wednesday, AMA President Dr. Nancy Nielsen asked the staid group meeting in the Chicago branch of the Federal Reserve Bank whether they were ready for a revolution.
Nielsen quickly explained, "It's a rhetorical question," before highlighting the need for reform. She talked about 46 million uninsured, growing health care disparities and the poorer outcomes for those lacking access to health care.
"This is an issue for our society to deal with and so far we've dealt with it by wringing our hands," said Nielsen. "The AMA is trying to deal with it."
As the U.S. economy declines, Nielsen predicts an increase in the number of the uninsured. "We hope Congress develops the political will to solve this problem," she said, pointing to a new Congress and president. "It is the right time. We're not calling for a single payer system. We don't think it would work and we don't think Americans will tolerate it."
Nielsen said neither the AMA plan nor any other organization's proposal is likely to be adopted by the next administration without revisions. "The AMA proposal won't prevail. Neither will McCain's or Obama's."
But she hopes that basic tenets of the AMA plan would be incorporated into a health reform proposal. She said the AMA plan empowers consumers to buy health insurance by revising the tax code. Currently large employers claim tax write offs for providing health insurance, a subsidy amounting to more than $220 billion annually, according to Ed Howard, executive vice president of the Washington-based Alliance for Health Reform, which advocates insurance coverage for all Americans.
Those who purchase insurance individually receive no tax breaks. The AMA is proposing sliding-scale tax credits or vouchers to make insurance more affordable and allow individuals to choose their own health insurance plans, doctors and hospitals. She said excessive government regulation makes health care more expensive and proposes reducing state health insurance mandates, protecting patients with health risks with subsidies.
The Alliance for Health Reform's Howard said the AMA plan hasn't yet achieved great traction. "But I admire Nancy Nielsen," he said. "She is smart, savvy and much more interested in reform that will help the system than some of her predecessors."
Howard said the recent economic collapse hasn't helped the cause of health reform. "But we don't know yet whether it will preclude, delay or scale back any action. Some say it makes it even more urgent to work on this.
Nielsen acknowledged that some earlier AMA health reform proposals were viewed more as protecting physician income than protecting patients. This time it's different, she said.
Ron Pollack, founding executive director of Washington-based consumer health organization, Families USA, said the AMA has been an active participant in a larger health reform organization called Health Reform Dialogue. "We're trying to find common ground," said Pollack. "These organizations aren't tripping over their specific proposals, but are trying to see what we can agree upon. No single organization will have its proposal as the one Congress will consider. That's a political fact."
Nielsen agreed. "We cannot let our differences stand in the way of doing something," she said. "We need a revolution. Society will have to make tough choices. Policy makers will have to make tough choices. Physicians must be involved, but the focus must be on patients. If the focus is on us, the focus is wrong and our country will get it wrong."
AMA President Nancy Nielsen underlined the high administrative costs of private insurers as part of the health care problem.
Data from 2006 National Health Expenditure report, U.S. Department of Health and Human Services
AMA will push its health plan no matter who wins
Data from 2006 National Health Expenditure report, U.S. Department of Health and Human Services
The American Medical Association is pushing for 2009 to be the year in which major progress is made in covering the one in seven Americans identified by the Census Bureau as having no health insurance, regardless of the November election results.
AMA President Nancy Nielsen told a gathering of business economists at the Federal Reserve Bank of Chicago that's why the influential Chicago-based association recently launched its “Voices for the Uninsured” campaign.
“It is not fair to let the market solve this,” Dr. Nielsen said, “because the problem of the uninsured is getting worse."
An existing AMA medical plan, which will be pushed by the new campaign, bears similarities to elements of both the John McCain and Barack Obama plans.
Like McCain, the AMA calls for the taxation of health insurance benefits received from an employer as income. The organization argues this would be fairer, since those who have to buy their own insurance do so with taxed income.
However, the AMA contends that McCain’s tax credit for insurance purchases is too small, and instead of being a flat credit, should be adjusted based on income, like Obama’s plan. It would allow those with insurance to keep it, while providing government assistance for the uninsured to buy insurance.
But Dr. Nielsen said she does not believe either candidate will be able to push through his health care plan exactly as laid out.
“What we really want to know," she said, "is what are they going to do in January?”
During her luncheon talk to the Chicago Association for Business Economists, Dr. Nielsen named a handful of western nations whose health care system she has examined “What these countries are asking is: what is the appropriate balance between publicly funded care and private insurance?” she said. “Cost is driving the discussion."
Cost is an important part of the conversation here too. In 2006 the U.S. spent $2.1 trillion on health care, according to the journal Health Affairs, about 16 percent of that year’s gross domestic product.