i bet the ama is also agst sotomayor, especially since, as medical professionals, they know she has 'gender' and 'race' like all the poor powerless people who'd flock to a public health plan -- and so unlike the white guys who dominate the ama.

why they're gender/race free, those rich pigs...

oink oink, ama, oink oink...

By all means ignore the experts on the subject: older doctors.

If we explain to you that health care is a privilege, not a right, just try to challenge our authority. Good luck getting one of us to treat you next time you need to be bled by leeches or given Lydia B. Pinkham compound for your female problems.

I really wonder how representative this organization is. i don't know a doctor who is not disgusted and angry with the current system. Most would be happy with a single payer plan.

I really wonder how representative this organization is. i don't know a doctor who is not disgusted and angry with the current system. Most would be happy with a single payer plan.

That was the gist yesterday when a group of non-ama doctors testified before congress.

The AMA combines two things that make it reactionary.

One, the lobby shop of the AMA has to justify its existence so they come out against stuff like alternative medicine just because they see their job as defending turf.

Two, the process of training new physicians involves hazing so the people who complete the training will buy into the culture of specialty physicians charging exorbitant amounts of money.

I keep wondering why no one is citing all the European countries who have national health insurance and far better health ratings for their citizens than does the U.S.? We are idiots to allow this health crisis as well as these health costs to continue. But then, while we spend billions to fight against international violence against Americans,we allow our citizens to carry guns in our national parks(& anywhere else they wish)& these guns are used--to murder US citizens. What a childish, stupid country. We deserve what we get.

Hey libs, this is America! If we can't make profits from sick people, then we ought to just give the country back to the Indians. If poor people can't afford medical insurance, it will make them think twice about getting sick and being unpatriotic and stuff like that.

Over the last year we've addressed five of the six clogged ventricles of American Capitalism:
Banking & Finance; Credit; Real Estate; Construction; Automobiles. Now we're finally on to Insurance and we should expect the same kinds of complaints about government involvement.

The mantra needs to be, "We're investing in good health and this will save us money as it makes Americans healthier." Don't let the doctors spin this as government meddling. The government has a tremendous stake in good health.

The problem is the "Profit/Growth" mentality of Corporate America. Everything in the medical industry (insurance, pharmaceuticals, etc) is geared toward this goal, not patient care.

So remember boys and girls, PROFITS matter, not PEOPLE.

By all means ignore the experts on the subject: older doctors.

If we explain to you that health care is a privilege, not a right, just try to challenge our authority. Good luck getting one of us to treat you next time you need to be bled by leeches or given Lydia B. Pinkham compound for your female problems.
Posted by: Myke K on June 11, 2009 at 9:26 AM

LOL! Myke, you outdid yourself with that one!!

The AMA is a glorified men's club. It needs to be taken out and shot in the face Cheney style. Stick to writing journals about medicine, not policy.

Hypocrites.

The AMA profits off of sickness and disease, hat in hand to Big Pharma. The two organizations forgot what their job is- to help people stay well and not line their damn pockets so they can play Pebble Beach twice a year.
A healthy nation is a thriving, prosperous nation. Let's cut this insuro-terrorism off at the pass.

Does anyone know how the AMA breaks down in terms of specialists vs. GPs? Thx.

Only about a third of American MDs (and no DOs) belong to the AMA. They've had a steadily declining membership for years. They're dominated by specialists and responsible for screwing the primary care doctors. About 70% of primary care doctors favor single payer IIRC.

Nicely put, Mr. Benen. Obstructionism of basic human health rights is as obstructionism of basic human health rights does. I hope the AMA continues to screech as the public option decimates private insurance. Because, as we all know, that's exactly what we're talking about - the end of parasitic, obscene profit mongering off the 'revenue stream' of human misery, and by extension institutions dedicated to indefensible defense of same. Good riddance to both.

I wonder how well the AMA represents the opinions of its membership on this issue. Doctors especially should speak up if they disagree. They're losing money on the admin costs associated with the nonsensical bureaucracies maintained by private payors. With regard to their personal coverage, perhaps doctors would like choice for their families as well.

A side note--in selling this plan we have to remind voters about how the current employer-based insurance system is killing our competitiveness in the marketplace relative to countries with public insurance plans.

And, of course, it is Medicare, which the AMA fought, that is largely responsible for the remarkable prosperity Doctors have enjoyed over the last several decades.
If you know any Doctors, with a few exceptions, their knowledge of basic economics is awful and worse.

Unlike tax exempt hospitals (70% of all hospitals), physicians do not have to provide care to anyone regardless of ability to pay. They are free to say no to anyone trying to get an appointment who doesn't have insurance. Many physicians are as busy as they want to be. A public option would mean more paying customers, but there's no guarantee docs will get paid what they want, so there's no upside in their minds.

From the first junk mailing I got from the AMA in medical school in 1976 until today, I despise that organization. I always believed that over time there would have to be a change in their approach as the older guard left or died out, but obviously it never happened. I'm ashamed.

I don't believe healthcare is a human right, I think that is an incorrect argument.

I support single-payer, government run health insurance. Just as I support government-run police and government-run roads and bridges.

However, having roads to drive on, a police to protect us, and affordable healthcare are all privileges in my view. Privileges of living in a representative democracy.

I probably sound like a broken record, but doctors/hospitals hate the insurance industry but realize that it is a useful enemy, in that it makes it quite easy to deflect concern from their own economic and quality failings.

The fragmentation of the system allows them to hide the ball rather well and make claims that cannot be refuted (like, Medicare doesn't pay me enough!) because the system is so confusing.

It's time to put up or shut up: acknowledge the weaknesses in the fee for service and organizational fragmentation that exists and suggest something better. Standing there and just saying no is no longer an option.

Salvo One: Educate and incentivize more doctors to become PCPs by co-opting and copying a rational version of "concierge" practice that lets them care for the whole person if they can and limits the need for a patient to be continually referred for specialty care simply because the PCP isn't paid enough to spend enough time with a patient.

I wish Obama, when speaking to the AMA, would confront the organization directly on its record: their opposition to Medicare, their past opposition to other reforms. He could ask if doctors are really happy to have to hire armies of clerical staff to do war with the insurance companies to get paid. But he won't; he'll make nice.

My father was a physician. When he got mailers from the AMA dunning him to sign up he would write snide remarks on the application and mail them back in the postage paid envelope so that they would have to pay the postage on them.

I'd think after all these years doctors would be tired of their marriage of convenience to the insurance industry. How much more of this abuse of pricing, denial, and wait time for services is going to go on until the AMA sees the wisdom of divorcing the lecherous pencil pushing geek! -Kevo

I'll preface this by saying I am a physician.

This subject seems to bring out the near troll on both sides. I grant you that the AMA position doesn't seem to make a lot of sense as a policy but you have to realize that the AMA probably doesn't represent (at least) a large plurality of physicians in this country any more.

There are other physician organizations that have become much more aware of the problems in the delivery of medical services (which is the focus here) in this country and the influence of both Pharma and Insurance on the issues. The Institute of Medicine has issued strict limits on medicine-industry contacts for example. (IOM report "Conflicts of Interest in Medical Research, Education, and Practice")

Physicians, especially young physicians, are aware of the need and consequenses of change in the system. Physicians are no friend of the insurance companies for a variety of reasons including interference with doctor-patient relationships: employers change insurance plans on an average of once every three years - which can mean having to change doctors, not enough time for a physician to develop a long term relationship, they dictate by economic means what medications can be used, and they are the gatekeepers to all services. Assuming that the insurance company makes money by saving money (and assuming that they also make money on administrative costs) you can do the math and see how they are more of a confounding factor than a helpful one even though theoretically they should be a force for efficiency. The formula is to keep down their costs in order to enhance profit, not to keep the costs of treatment down. The overall cost of services and service delivery is not changed. Administrative costs are a significant part of the cost of medicine. (Granted not the only one, of course, there are multiple other factors many of which are not addressed by anyone such as the cost of amortization of technologies that are no longer state of the art but are still present, the cost of medical education, legal costs, costs of compliance with thousands of regulations, etc.)

There is no doubt that there are physicians, often physicians in positions of power, who have been corrupted by the Pharma and Insurance. JAMA has documented this time and again, especially in the relationship between physicians and Pharma. In my own practice I stopped seeing drug reps 25 years ago. I also stopped being a member of the AMA because they (still) are working hand in hand with Pharma and I dislike the control they try to impose on physicians, even those who are not members. (A complex issue having to do with mailing lists, access to physician prescribing practices, and constant jawboning to get physicians to back AMA policies even when they are not productive as in the case of public insurance - which already exists for a sizeable portion of the population.)

So if you just think it is just "rich doctors", think again - I know a few who are obsessed with money, but a lot of them are still in debt due to the high cost of education. If you think it is defending turf, some of that is true, but there aren't enough primary care physicians out there as it is and some of the solutions are very acceptable to a lot of doctors. If you think your doctor is in the business for the money only, then get another doctor.

I heard someone once say that physicians are Republicans because of their incomes and Democrats because of their patients. The IOM is much more that than the AMA. The AMA is not the voice of medicine these days.

Thank you, AMA, for reminding me once again why I am not a member.

Mikeyes, as someone who counselled physician owned HMOs in the "early days" of managed care, I continue to regret that the HMO phenomenon was co-opted by commercial insurers who quickly tried to use the model to serve profit not patients. But the "managed care backlash" was aimed not only at abusive practices, but at many practices that had the potential to be highly beneficial, and to promote, in particular, the role of PCPs versus specialists in organizing and directing care of the whole patient. That needs to change, urgently, otherwise, it really doesn't matter from my perspective, who writes the check or how much physicians are paid.

All we have to do to beat the insurance companies and their friends at the AMA is point out that the only reason they don't want a public option is because they are afraid they can't compete. Think about that. They are so horrible they can't compete head to head with the government that Republicans insist is utterly incompetent.

I have to assume they're in bed with the insurance and pharmaceutical industries, no honest doctor actually believes that our current mess of private insurers, multiple layers of red tape, and regular second guessing of medical decisions is a system that should continue. Unless they're also benefiting from it while people go broke, bankrupt, get sick and die. Disgusting.

So about 1/3 of doctors belong to the AMA, and about 1/3 of Americans self-identify as "conservatives"...you think maybe we're seeing a pattern here?

Really no surprises here - AMA doctors don't want to have to negotiate lower fees, as they would undoubtedly end up having to do with a public insurance plan, since from inception it will be the largest insurer in the country with 50 million + people. And they fear intervention in their satellite profit schemes, such as when a group of doctors owns a speciality hospital or piece of equipment...all the doctors in the group make sure the hospital/equipment gets well utilized, and the costs go through the roof. The New Yorker had an excellent article about this exact issue, sorry I can't be bothered to post a link since I'm not sure if it was in the current issue or sometime in the last several months. But shit like that is going to have to stop unless we're all content with paying a lot more than we do now to cover everyone, instead of covering everyone and paying a little less than we do now.

I could see us ending up with a model like Switzerland has, if we could get the Randians over this hump of insisting that the right to unlimited profit is the highest calling of mankind. Providing a basic human need such as water or health care can't be left up to an unregulated free market without bad consequences. We saw that with utility deregulation. Enron, anyone?

Anyway, back to the Swiss model: all insurance is private but insurers are not allowed to profit on basic care policies and are not allowed to refuse coverage to anyone. Everyone is required to have insurance. Insurers compete for customers on their supplemental policies, which they are allowed to earn profits on, and which almost all Swiss citizens carry. It's instructive though, that in this model that bends mightily to the private interests, the Swiss system ends up the second most expensive in health care in the world. So it's far from ideal. But the Swiss situation is similar to our own in that they until very recently had no universal healthcare - they've only had this in place since 1994, and when it passed by referendum then, it was by the barest majority.
We could do better than the Swiss model in terms of cost savings, but even it would cover everyone while saving us money and perhaps be more politically possible.

Frontline had an excellent show called Sick Around the World, which looked at the universal health coverage in 5 other capitalist democracies. Highly recommended viewing, and you can watch it online.

mikeyes, I appreciate your comments. But, right now if a doc is willing to move to a new location, it is becoming standard in employment agreements to have generous loan repayments, precisely because we are short of physicians. Any doc who is burdened by student loans can find someone to pay them off for him/her.

The AMA is to the medical profession as the American Legion is to veterans: growing ever older, crazier, and less relevant by the year.
. . . jim strain in san diego.

Providing a basic human need such as water or health care can't be left up to an unregulated free market without bad consequences.

I agree 100% and have always felt the same way. The health and lives of people should not be left to the whims of the free market and lust for ever more money.

I appreciate what mikeyes wrote.

My son is currently completing the 5th year of a 6-year residency in a surgical sub-specialty. When he is finally able to take a position paying real money he will be 36 and will still have loans from medical school.

Rolla sez:
"mikeyes, I appreciate your comments. But, right now if a doc is willing to move to a new location, it is becoming standard in employment agreements to have generous loan repayments, precisely because we are short of physicians. Any doc who is burdened by student loans can find someone to pay them off for him/her"

Rolla,

That used to be true and may be true in some cases, but my son has not received any offers like that and the clinic I am attached to no longer offers debt repayment as part of the package and we are in a semi-rural area.

From what the administrator of our hospital tells me, the practice of repayment has gone by the wayside for most places as it is too expensive (we are talking $150,000 to $300,000 or more.)

You go Joe Buck @ 10:17!!!!
I totally get that the MSM is in the tank for the pro-business interests (which makes them amplifiers of their enables – the wingnut GOP). But rather than constantly whine about it, here is the perfect opportunity for Obama to publically chronicle the AMA’s history of obstruction and frame them in Kevin Drum’s terms. That the Donkeys consistently lack the cajoles to take advantage of these opportunities as well as the fact that there are turncoats to the progressive movement within their own ranks convinces me that some how, some way, corporatists will continue to rape the land and its inhabitants.

mikeyes - must be a regional thing. Tell your son to check out Missouri.

With all respect to all physicians who have commented here it's incredibly hard to feel sorry for the financial situations of doctors. They have an average income far surpassing that of most americans. That's an irrefutable fact. If they have to wait a few years to become relatively wealthy that's too bad. Most americans not only never reach that level they don't even have the opportunity to do so.
One thing's for certain they don't have to worry about healthcare unlike many millions of americans who don"t have or have substandard health insurance.
Anyone who thinks that the present situation is ok is deluding themselves on a whole number of levels. If the socialized style of paying for healthcare that most European countries and Canada have is so bad then A, Why isn't there an outcry from there populations to change and B. Why do the statistics bear out a much healthier and longer living population?
And by the way many of my relatives are doctors.

The AMA is like the NAM (National Association of Manufactures) -- they're guiding stars in reverse: no matter what the issue, if they're for it, start heading in the other direction.

Isn't it ironic that the AMA fought bitterly in 1964-65 against the only true national health insurance plan that we have in the USA, (Medicare), yet its members have pocketed trillions of dollars in Medicare payments over the past 40+ years. If they lose the current battle, I'm sure that the additional trillions of physician income their members will receive from a national plan in the next decade will help to ease their pain!

If some of you claiming to be physicians really are physicians, you're traitors to the profession.

You idiots, currently the government spends 70% of every dollar it spends on health care for administration cost. That means ONLY 30% is being spent for ACTUAL HEALTH CARE. Private insurance is the exact opposite, 70% to direct care and only 30% in administration cost. Do the math, do we really want the government spending trillions more to buy for the wages of MORE beaurecrats? Go educate yourselves on the topic before you open your ignorant mouths on a topic you know nothing about.

Cathy B wrote: "You idiots, currently the government spends 70% of every dollar it spends on health care for administration cost."

You are a liar.

Cathy B wrote: "Private insurance is the exact opposite, 70% to direct care and only 30% in administration cost."

You are a liar.

gandalf sez:
"With all respect to all physicians who have commented here it's incredibly hard to feel sorry for the financial situations of doctors."

Gandalf,

I don't think anyone is asking for pity because they are doctors. Physicians services are valuable and valued, even in the most socialized countries (with the possible exception of Cuba. Apparently there is a joke about a woman complaining that her boyfriend lied to her,"He told me he was a cab driver - who earns money in foreign currency - and now I find out he is a neurosurgeon.")

Any physician who bothers to look at the issue of availability knows what you are saying. While we are running a business, and by definition a business is there to make money, the income is only a perk for most of us. One that we expect, but not the reason for our existence. While there will always be doctors corrupted by the money, for the most part physicians earn what they make.

There will always be criticisms of closed shops, greed, and over valuing services, but the business of being a doctor (as opposed to the business of medicine in general) is like any other business. There are large startup costs, tons of time consuming paperwork, massive regulations on every level, financial risk especially in some fields, and most physicians are not good business men(or business women as more than 50% of graduates are women.)

I won't apologized for my income, a lot of people with my level of education make a lot more money than I do, but I will refer you back to the statement I wrote about being both Republican and Democrat. I know a few doctors who revel in their income but most of the ones that I know are obsessed with being a good doctor and taking care of patients. They hate the fact that they can't establish long term relationships with patients and their families, that they have to limit the time they see patients due to lower per-capita payment schedules and the fact that medicine has become an industrial business instead of the cottage industry that it used to be 30 years ago.

mikeyes, you are simply wrong. There is virtually no other sector of society that can habitually expect to make the same salary ON AVERAGE that physicians do. Of course you can slice and dice comparables all you want, but you will be hard pressed to find an entire profession with a comparable number of members with anything approaching a comparable average income -- and it is much higher in the U.S. than in foreign countries.

One of the problems that physicians in the U.S. have is that they are too focused on "running a business" because they have traditionally resisted alternative practice arrangements that allow the business aspects to be more of a shared responsibility.

You may think you do what you do for other than money, but those of us who interact with you and your staff might have an alternative view.

But the real problem in American medicine isn't physician income per se, it's the gross imbalance of income and ratios between primary care physicians and specialists. Nothing will get better until that is addressed.

Every American deserves affordable, high-quality health care coverage and working toward health reform that covers the uninsured is the AMAs top priority. While the AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, we are willing to consider other variations of a public plan that are currently under discussion in Congress. This includes a federally chartered co-op health plan or a level playing field option for all plans. The AMA is working to achieve meaningful health reform this year and is ready to stand behind legislation that includes coverage options that work for patients and physicians.

Barbara sez:
"One of the problems that physicians in the U.S. have is that they are too focused on "running a business" because they have traditionally resisted alternative practice arrangements that allow the business aspects to be more of a shared responsibility."

I'm not quite sure what you are talking about, but am interested in learning. If by "alternative practice arrangements" you mean group practice, that is the norm these days as a solo practice is not feasible in most markets and most physicians are in a group practice so some sort that takes advantage of sharing costs. If you mean employment as a model, a third of all physicians are employees of an entity such as a hospital or a non-profit organization.

Other arrangements are certainly possible, I suppose, but many states have laws that preclude certain types of business arrangements in the medical field.

I will state that physician salaries are but a very small part of the cost of medicine. Administrative costs are much higher as a whole and the thrity percent figure quoted above is probably close to correct for private insurance companies while the 70% figure quoted for government plans is not - more like 5%-10% adminstrative costs unless you decide to throw in every cent ever spent that had any relationship to the regulation of medical care which is simple pettifoggery.

Again, I don't think that the salaries of doctors is the main issue here. Part of reform will be to develop public policy that looks at salaries and how doctor's earnings will effect the overall quality of care including making sure that physician standards are at the highest levels. The prospect of earning less money may not be a hinderance to quality, but the jury is still out on that. When all is said and done, physicians as a group will probably still do very well. It is part of the way medicine has developed in this country and a case can be made that it helps draw the best and brightest (well at least IQ in the 120-130 range) into the field.

It's also intersting to see Dr. Nancy Nielsen's response. The AMA has always had issues with the payment aspect of Medicare - some times this is appropriate in my opinion, but not always - but they seem willing to look at alternatives. This is what an advocacy group is supposed to do. I don't generally like what they say, but I appreciate the fact that there is advocacy out there. At least they seem willing to negotiate which means they are willing to compromise. But as has been pointed out by several responses, the AMA does not reflect the total set of views in American medicine.

Dr. Nielsen, shame on you. As a low income worker who does NOT have health insurance and has two chronic conditions which means I have been denied an individual plan, I say "level playing field" my ***. I'd like a level playing field that allows me to have health insurance. Everyone should check out open secrets info on AMA's lobby dollars spent.
http://www.opensecrets.org/lobby/top.php?indexType=s

Obscene. AMA is number 2, spending MORE than Exxon/Mobil for god's sake! (Along with American Hospital Association, AARP, and Pharmaceutical Research & Mfrs. of America!). Now dare to tell me you aren't about profit and business at the expense of the health of individual Americans.

As the wife of an ER Physician I know firsthand how many abuse the free system that is already in place. Far to many people on welfare treat the medical care they recieve as "if its free, its for me" and use it inappropriately. Every single shift my husband works there are 2-4 visits by these idiots who show up in the ER for minor, chronic, social or other inappropriate reasons, such as: 2am patient arrives because he/she has a cold and wants a doctors note to not go to work, EXCUSE me but that is not an ER visit. Has anyone heard of a recent cure for the common cold being dispensed? NO! Or the fool who shows up at 10pm with a back ache, Doctor asks patient "so how long has it been hurting and how did you hurt your back?" patient responds, "3 months". Excuse me but thats not an emergency! Then there are the drug seekers who are always in with one made up story or another looking for whatever they can get their hands on and they are always ALERGIC to whatever isnt narcotic. Then we have the social morons who have nothing better to do on a Thursday evening so they walk or ride in on an ambulance (they think an ambulance will get them seen faster) with whater the illness du jour is.

My husband loves being a doctor and loves when he can truly help a patient, but the complaints from the fools come in with a sore throat and have to wait 4 hours is getting to him, excuse him but he was busy saving the life of a man having a heart attack, waiting for lab results for the woman with a 105 temp, has a rape examine waiting to be seen and the list goes on. Talk to ANY ER doctor in ANY ER and the ammount of waste by these freebies for me patients would be enough to give care for an enourmous ammount of others.

Want the paycheck he brings home? It took him 4 years of college, 4 years of medical school, 4 years of residency/internship to get there and while he was busy doing that he wasnt earning much and now we have a mortgage for a VERY nice house except we dont live in it, its his mortgage for school. We have a friend who owns his own auto repair shop with 1 other mechanic and he takes home after taxes and insurance to do business (guess who's insurance is 10 times more) more than my husband does, the mechanic went to school for 2 years after high school.

Wow, talk about living inside the bubble. Cathy B, do you know how hard it is to find a PCP, and even if you have one, to be seen in short order?

Maybe not for spouses of doctors, but for the rest of us.

I'll never forget reading an article by Steve Case -- Yes, THAT Steve Case -- about how he felt compelled to start Minute Clinic (or something comparable) when one of his kids got a high fever and he couldn't locate a doctor on a weekend -- so he ended up sitting in an ER for 4 hours, dealing with people like your husband sneering at him for "abusing" the ER. For shame.

Mikeyes, agree with most of what you say. In actuality, though, many doctors still practice as part of surprisingly small groups. The administrative inefficiencies are brutal. I'll try to link to an article about how to combat them that I recently read.

Mikeyes
To bad you cant read. What I posted was about those who abuse the system not those who need it, and the incredible waste of resources by those who abuse it. How much longer did you have to wait in the ER before being seen because of the abusers?

Cathy, Many people, literally, have no access to doctors working in offices. None. What don't you get about that?

Now what dont you get as abuse of the system?

9 patients made nearly 2,700 ER visits in Texas

Associated Press

AUSTIN, Texas (AP) — Just nine people accounted for nearly 2,700 of the emergency room visits in the Austin area during the past six years at a cost of $3 million to taxpayers and others, according to a report.

The patients went to hospital emergency rooms 2,678 times from 2003 through 2008, said the report from the nonprofit Integrated Care Collaboration, a group of health care providers who care for low-income and uninsured patients.

"What we're really trying to do is find out who's using our emergency rooms ... and find solutions," said Ann Kitchen, executive director of the group, which presented the report last week to the Travis County Healthcare District board.

The average emergency room visit costs $1,000. Hospitals and taxpayers paid the bill through government programs such as Medicare and Medicaid, Kitchen said.

Eight of the nine patients have drug abuse problems, seven were diagnosed with mental health issues and three were homeless. Five are women whose average age is 40, and four are men whose average age is 50, the report said, the Austin American-Statesman reported Wednesday.

"It's a pretty significant issue," said Dr. Christopher Ziebell, chief of the emergency department at University Medical Center at Brackenridge, which has the busiest ERs in the area.