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Congressional Democrats to AMA: Go Pound Sand

By: Brian Faughnan (Diary)  |  January 24th, 2010 at 05:14 PM  | 

RESIZE: AAA

Here’s a completely unsurprising and predictable story.

Do you remember how many conservatives spent months trying to figure out why the leadership of the American Medical Association signed the nation’s doctors up in support of Obamacare? Many conservatives argued that the AMA was being shortsighted – that Congressional Democrats would ultimately betray the AMA, despite the powerful group’s consistent advocacy of the president’s health care rationing bill. We knew that the AMA had made a deal with the devil: they backed Pelosi and Reid only because they promised the ‘doc fix’ – permanent relief from huge reductions in Medicare reimbursements. We said that Democrats would use the AMA endorsement and then turn against the group when they had the chance.

Well, we were right:

‘Doc Fix’ Could Be Left Stranded as Health Care Overhaul Founders

Those who follow the long-running doctor payment saga say the poisoned atmosphere surrounding health care spending makes it difficult to see how Congress will agree to the hundreds of billions of dollars needed to make a permanent change in the payment formula. The Senate has rejected attempts to pay for the 10-year cost without offsets.

But there is also mounting pressure from the influential doctors and seniors lobbies to do something — and fast — out of fear that beneficiaries will lose access to care. Those who advocate a permanent fix point to the recent news that physicians at a Mayo Clinic family practice clinic in Glendale, Ariz., have decided to try opting out of Medicare.

Doctors who treat Medicare beneficiaries face a 21.2 percent cut in their payments, starting March 1…

“Clearly, for physicians, something needs to be done by March 1 or there’s a big problem,” said Julius W. Hobson Jr., a lobbyist at the law firm Bryan Cave LLP and a former director of congressional affairs for the American Medical Association (AMA).

The good news for the AMA is this: Congress has never let these cuts go into effect, and they’re unlikely to now. At worst, the doctors will probably see a one-year ‘patch’ for the cuts. It’s less than they want, and less than they bargained for. But they made a deal with a Congressional leadership that sees them as nothing more than a tool, so they’re lucky to get that much. Democrats have plenty of reasons not to give permanent relief from the cuts – not the least of which is that it will keep the AMA coming back for more help in the future.

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COMMENTS

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  • http://vbushmills.blogtownhall.com/ vassar

    …why not give the AMA leadership the heave-ho?

    They were bribed in one way or the other..

    Cheers

    • thurman

      Only about 17% of us docs belong to the AMA– most of us fired the AMA altogether as our mouthpiece years ago.

      The AMA is just a bunch of lefty nutjobs and clueless academic types, and a few primary care docs who often harbor resentment against more specialists in more lucrative fields

      The AMA doesn’t represent docs well, and burned even more bridges

      It was sickening watching Obama proclaim their support for him over and over to try to trick the people into thinking that their docs supported this garbage

      The fact that the AMA has the arrogance to say they speak for us docs was sickening

      The pathetic part is that Obama openly said at the outset of his talks that he was willing to dangle tort reform as a carrot for the docs to sign on

      Instead, the AMA pathetically jumped on board with no leverage and lost any chance at tort reform

      Then, the Senate jettisoned the Medicare SGR fix to cook the books and try to trick the MSM/public about the dollar figure (this way the final sum was 270 billion less)

      Now the AMA has zero leverage, zero tort reform, and 21% Medicare cuts looming in a month with no hope of a permanent fix

      They’re just as incompetent as the Dems they’re in bed with

      Congress will pass another one year patch I’m sure but all in all, I’d rather deal with this for the next few years than the miserable year of uncertainty we’ve spent watching this unfold

      • ihateliberals

        Any of the large support groups and the Unions were tricked by Harry and Nancy. Those tow are the Devil. AARP is another group that i have parted compnay with. I now belong to AMAC and GENA. these groups aren’t in bed with the Dem’s. Medicare is a perfect example of what will happen if the Health Care bill is pasted. As soon as the money gets tight they will start cutting services, Better know as rationing. Anyone tht supports this Health CAre bill is just evil and most like have not read the bill or understand most things in it.

      • merryj1

        …my own Congressman (IL 6th) Peter Roskam (R) has talked about a shield law that would prohibit litigation against medical practitioners as long as accepted procedures were followed; ambulance chasers would have to demonstrate actual malpractice to get a law suit onto a docket. Obviously, with the current Congress there’s no chance of getting anything remotely fair up for a vote, but even assuming 2011 has a change in Party leadership and tort reform gets through, this sounds like a prudent measure — especially if coupled with a “loser pays” clause.

    • dwander

      Why don’t more doctors come out against the AMA? It appears, by the majorities’ silence, that the doctors of America support the effort of AMA to socialize our medical fields.

      Maybe doctors can get more vocal in their thoughts about the AMA?

      • denniswayne

        Actually, quite a few doctors’ associations have come out in opposition. However, these tend to be organized around a given specialty or to be regional while the AMA is cross-practice and national. If all the physicians represented by these smaller groups were to be added together, the number would be greater than those in the AMA who support its position. National polls have shown a majority of doctors oppose the legislation. IMO the primary reasons the opposition’s voice is not heard is (a) the AMA is the only national establishment organization with lobbyists in DC and (b) the AMA is viewed as the “legitimate” national voice by the NY-based media, which conveniently shares the position of said media and (c) the WH & Congress has cut all the others out of the conversation because they won’t do a deal, and hence again there isn’t much coverage of them.

        • Warrior

          organization. Like AMAC is challenging AARP and so on. The lawyers, too. I believe their situation is similar to the AMA. The ABA represents a minority of lawyers, but it is national, interdisciplinary/specialty, has paid lobbyists and is in bed w/NYC media clowns.

  • E Pluribus Unum

    If you are a leftist pressure group………. you are a bunch of idiots led by idiots.

    You’d think grown-up ladies and gentlemen with advanced degrees could assemble themselves into an organization and choose people to represent them that actually..ah….represent them.

    I’m going to take it that the good doctors in the AMA have chosen well. Making them all a pack of idiots.

  • Scope

    He had them broken into two groups. The ones that supported Obamacare, and the ones that didn’t on the other side of the room. The Docs that didn’t support it outnumbered the others. The ones that supported it were all young, and, as was noted, still paying off their college loans. Those youngin’s will eat cake.

  • http://www.neoavatara.com/blog neoavatara

    As a doctor, no one at the AMA should be surrprised that doctors will get screwed. We are the ‘rich’ that Dems like to hate, and it is easy to demonize us. We of course will be the first to be sacrficed on Obama’s alter of expediency.

    • merryj1

      Your patients will be the first ones sacrificed.

  • jccbin

    the very lucrative diagnostic/procedure coding business. You know, all thoses codes the docs, insurance companies, etc use to define a diagnosis, etc… AMA was the sole source of that info, for a price. They got to keep that cash cow under Pelosicare as well. Many, many millions of dollars each year.

  • mbecker908

    Medicare payments drop 21%. Doctors/hospitals stop treating medicare patients. Medicare patients die at a greatly accelerated rate.

    Problem solved.

  • bobojake
  • bk

    AARP should be all for it right? They said it would not take a penny out of Medicare services.

    • mosander

      Which is why I resigned. Instead of looking out for the interests of seniors, they sold us out. Many have resigned but not nearly enough people realize this group is no better than ACORN. They were a powerful lobby but their membership is shrinking. At the current rate, seniors will have no health care. Reimbursements were dismal at the current rates, dropping it 21%, doctors would have to work for free.

  • muffin

    Another one under the bus. Apologies to Weird Al.

    • MF

      Apologies would actually be first directed at the rock back Queen, from their original song, “Another One Bites The Dust.”

      • muffin

        n/t

        • http://www.hakubi.us/ Neil Stevens

          One vision aside, you don’t need to be waiting for the hammer to fall.

  • writeblock

    …What about the Senate bill itself? Is it actually dead–or hibernating till the elections are over and the bill can be passed by House dems who will by then have nothing to lose…

    • mosander

      Obama has ignored many laws violating the constitution. The noise about making a UN treaty is ominous – mainly because even though it would have to be ratified by congress, I doubt if Obama would bother. He plans are likely to take us out by force if nothing else works. He keeps talking about “civil unrest” which he is trying to provoke. Tea Parties are MAIN STREAM AMERICA. He is just trying to label Christians who oppose liberal policies (which our right under the US Constitution). He knows it, he just is trying to respin things.

  • http://www.doctor-bob.biz rsklaroff

    http://www.doctor-bob.biz/AA-Political%20Essays/Domestic%20Concerns/ama.htm

    http://thebulletin.us/articles/2009/11/17/commentary/op-eds/doc4b025cc78215e487973886.txt

    Hijacking the AMA?s Endorsement:

    A Tale of Two Press Releases

    By Robert B. Sklaroff and Robert R. Guzzardi

    Did the AMA truly endorse ObamaCare this weekend? Not really, notwithstanding media reports.

    To understand the dynamics of what transpired, it is necessary to depict the interaction of the House of Delegates (which convenes semi-annually) and the President (who conducts business in the interim). All actions of the latter must be divulged to and corroborated by the former, recognizing that public emergence of any schism would foment embarrassment ?enervating to the AMA and, thus, to both.

    Why physicians cannot, instead, become energized by the healthcare reform debate is dramatized by events of the past five days. They can easily be tracked by consulting one page on the AMA?s web-site?after one learns how to interpret both ?commissions? and ?omissions.?

    Policy is Codified

    What happened during this Interim Meeting can be divined following a critical review of the hyperlinks originating on the ?Meeting Highlights? page (http://www.ama-assn.org/ama/pub/meeting/highlights.shtml).

    During this convocation, four core principles adopted at the Annual Meeting this past June were reaffirmed (pluralism, freedom of choice, freedom of practice, and universal access for patients) and elucidated thusly:

    Health insurance coverage for all Americans;
    Insurance market reforms that expand choice of affordable coverage and eliminate denials for pre-existing conditions or due to arbitrary caps;
    Assurance that health care decisions will remain in the hands of patients and their physicians, not insurance companies or government officials;
    Investments and incentives for quality improvement and prevention and wellness initiatives;
    Repeal of the Medicare physician payment formula that triggers steep cuts and threaten seniors? access to care;
    Implementation of medical liability reforms to reduce the cost of defensive medicine; and
    Streamline and standardize insurance claims processing requirements to eliminate unnecessary costs and administrative burdens
    ?Chicago-Style Politics? Intervene

    In lieu of addressing the ?public option? controversy, AMA rendered this generic endorsement, even as other entities within the structure of organized medicine?both independent of the AMA and subsidiary thereto?opted to deviate from this script.

    The not-so-silent hand that had created this discrepancy was unearthed during a site-visit this past summer to the Illinois Medical Society headquarters, which had staked-out a neutral posture. The AMA?s imprimatur was juxtaposed by opposition by the Chicago Medical Society because the former had been garnered?at least in part?due to the Administration?s pledge to endorse the annual ?doctor fix,? reversing the 21.5% Medicare reimbursement cut scheduled for January, 2010.

    That physicians are paid less than they were at the beginning of this millennium (despite rising overhead) is to be ignored; rather, their endorsement is to be extorted, even if the payoff is subject to being rescinded during subsequent years. The shifting alliances and pledges afoot are illustrated by how endorsements were amassed from other stakeholders, only to be undermined by a classic ?bait and switch? tactic. Recall that insurers had funded the iconic ?Harry and Louise? kitchen-table-discussion of complaints against ClintonCare, while this year?s couple had endorsed ObamaCare. Through it all, the Administration shoulder-shrugged, claiming Congress was merely functioning independently.

    The President Pre-Empts

    Immediately after the House of Representatives approved ObamaCare Saturday night, the AMA President hailed its passage. This transpired before the House of Delegates could assess resolutions in opposition thereto, scheduled for testimony on the following day in Reference Committee B. His awareness thereof, which was overtly phrased as intending to reign-in his out-of-touch Board of Trustees (by, for example, mandating roll-call votes thereof) constituted a brazen challenge to this policy-making body to dare to undo what he had already trumpeted.

    As anticipated, it relented. Gone were citations of policies promoting Health Savings Accounts and the need to rescind the McCarran-Ferguson antitrust pre-emption enjoyed by health insurers, for these were inimicable with ObamaCare. Inserted were specifications regarding insurers (?elimination of denials due to pre-existing conditions is understood to include rescission of insurance coverage for reasons not related to fraudulent representation?) and insurance exchanges (?be self-supporting; have uniform solvency requirements; not receive special advantages from government subsidies; include payment rates established through meaningful negotiations and contracts; not require provider participation; and not restrict enrollees? access to out-of-network physicians?).

    The House Sends a Message

    How did the House transmit its displeasure with the President?s unilateral action, without communicating overt antagonism? By compiling its objections to key facets of ObamaCare, to wit:

    ? Reduced payments to physicians for failing to report quality data when there is evidence that widespread operational problems still have not been corrected by the Centers for Medicare and Medicaid Services;

    ? Medicare payment rate cuts mandated by a commission that would create a double-jeopardy situation for physicians who are already subject to an expenditure target and potential payment reductions under the Medicare physician payment system;

    ? Medicare payments cuts for higher utilization with no operational mechanism to assure that the Centers for Medicare and Medicaid Services can report accurate information that is properly attributed and risk-adjusted;

    ? Redistributed Medicare payments among providers based on outcomes, quality, and risk-adjustment measurements that are not scientifically valid, verifiable and accurate;

    ? Medicare payment cuts for all physician services to partially offset bonuses from one specialty to another; and

    ? Arbitrary restrictions on physicians who refer Medicare patients to high quality facilities in which they have an ownership interest; and

    ? Creation of an Independent Medicare Commission (or other similar construct), which would take Medicare payment policy out of the hands of Congress and place it under the control of a group of unelected individuals; and

    ? Replacement of the sustainable growth rate (SGR) with a Medicare physician payment system that automatically keeps pace with the cost of running a practice and is backed by a fair, stable funding formula; and

    ? Creation of a single-payer system.

    This ?something for everyone? approach served to beg the question of whether the specifics of ObamaCare should have been endorsed. Meanwhile, however, the weight of the AMA?representing all of 17% of practicing physicians?can now be used by the Administration to administer this poison-pill program to a reluctant America.

    ?The Bobs? are Robert B. Sklaroff, M.D., Abington Township GOP Committeeman (rsklaroff@comcast.net) and Robert R. Guzzardi, Esquire, Conservative Reform Network blogger (bobguzzardi@yahoo.com).

  • makemyday

    I would think we should consider it like Prohibition rather than Social Security.

    People are going to want their care in spite of what a board deems cost effective and they will get it anyway they can. I believe the world has turned upside down when a woman can walk in the front door and get a government paid for abortion, while someone needing a pacemaker or heart transplant will have to find it in a back alley somewhere.

    “Speakeasy” clinics are not farfetched idea.

  • freedomofthought

    About the concept that doctors are rich;
    Given the current reimbursement to doctors for medicare
    essentially going down vs. actual cost of doing business,
    and burgeoning “malpractice insurance cost” — is it not
    true that many doctors (esp. “GP”s are selling Amway on the side?

  • furious

    …sold out their membership, and now the Admin. won’t come through with the Medicare-fix payoff. Couldn’t happen to a nicer bunch of suckers.

    The Cook County Machine pols in the White House are clearly dishonest — they won’t stay bought.

  • http://www.sheetanchor.org Sheet Anchor

    Please read and comment folks. Is this possible?

    Dick Morris: Pelosi and Reid Plot Secret Plan for Obamacare

    Sunday, January 24, 2010 05:54 PM Article

    By: Dick Morris and Eileen McGann

    Highly informed sources on Capitol Hill have revealed to me details of the Democratic plan to sneak Obamacare through Congress, despite collapsing public approval for healthcare “reform” and disintegrating congressional support in the wake of Republican Scott Brown’s victory in Massachusetts.

    President Obama, House Speaker Nancy Pelosi, and Senate Majority Leader Harry Reid all have agreed to the basic framework of the plan.

    Their plan is clever but can be stopped if opponents of radical healthcare reform act quickly and focus on a core group of 23 Democratic Congressman. If just a few of these 23 Democrats are “flipped” and decide to oppose the bill, the whole Obama-Pelosi-Reid stratagem falls apart.

    Here’s what I learned top Democrats are planning to implement.

    Senate Democrats will go to the House with a two-part deal.

    First, the House will pass the Senate’s Obamacare bill that passed the Senate in December. The House leadership will vote on the Senate bill, and Pelosi will allow no amendments or modifications to the Senate bill.

    How will Pelosi’s deal fly with rambunctious liberal members of her majority who don’t like the Senate bill, especially its failure to include a public option, put heavy fines on those who don’t get insurance, and offering no income tax surcharge on the “rich”?

    That’s where the second part of the Pelosi-deal comes in.

    Behind closed doors, Reid and Pelosi have agreed in principle that changes to the Senate bill will be made to satisfy liberal House members ? but only after the Senate bill is passed and signed into law by Obama.

    This deal will be secured by a pledge from Reid and the Senate’s Democratic caucus that they will make “fixes” to the Senate bill after it becomes law with Obama’s John Hancock.

    But you may ask what about the fact that, without Republican Scott Brown and independent Democrats such as Joe Lieberman, Reid simply doesn’t have the 60 votes in the Senate to overcome a Republican filibuster that typically can stop major legislation?

    According to my source, Reid will provide to Pelosi a letter signed by 52 Democratic senators indicating they will pass the major changes, or “fixes,” the House Democrats are demanding. Again, these fixes will be approved by the Senate only after Obama signs the Senate bill into law.

    Reid also has agreed to bypass Senate cloture and filibuster rules and claim that these modifications fall under “reconciliation” and don’t require 60 Senate votes.

    To pass the fixes, he won’t need one Republican; he won’t even need Joe Lieberman or wavering Democrats such as Jim Webb of Virginia.

    His 52 pledged senators give him a simple majority to pass any changes they want, which will later be rubberstamped by Pelosi’s House and signed by Obama.

    This plan, of course, is a total subversion of the legislative process.

    Typically, the Senate and House pass their own unique legislation and then both bills go to a conference committee. In conference, the leadership of both Democrat-dominated houses wheels and deals and irons out differences.

    The final compromise bill is then sent back to the full Senate and full House for a vote and has to pass both to go to the president.

    In the House, a simple majority passes the legislation. But under Senate rules, major legislation requires 60 votes to end a filibuster.

    As it stands, the House bill and Senate bill have major discrepancies. Reid does not have 60 votes to pass a compromise bill that would no doubt include some of the radical provisions House members have been demanding.

    But if the House passes the exact Senate bill that passed by a 60-39 Senate vote last month, there is no need for a conference on the bill. It will go directly to the president’s desk.

    There is a rub to all of this.

    This secret plan being hatched by Pelosi and Reid requires not only a pledge by 52 Democratic senators to vote later for the House modifications. House liberals must actually believe these Senators will live up to their pledge and pass the fixes at some future date.

    A Senate source cautions: ?Senators more than House members and both more than ordinary people, lie.?

    Still, my Senate source and others in Washington believe that the liberals in the House, grasping at straws after the stunning Massachusetts defeat, will go along with the Reid-Pelosi plan to bypass a conference bill and ultimately will vote for the Senate version without changes.

    Among the key “fixes” House liberals are demanding the Senate pass in reconciliation at some later date include a ?carve out? for unions from the ?Cadillac policy? insurance tax. The Senate plan funds their healthcare plan by heavy taxes on so-called “Cadillac” insurance plans that provide those insured with exceptionally good coverage including almost unlimited health access with little or no co-payments. The Senate’s view was that rich people have such plans and should be taxed for them to pay the less fortunate.

    But many unions have Cadillac plans for their members, and they are furious their members will be hit with the Senate tax. The unions have told their minions in the House to oppose the Senate Cadillac plan tax.

    House liberals also are requiring a fix that increases fines for those who flout the law and don’t buy health insurance (the Pelosi-passed plan includes criminal penalties, including possible jail time if a person doesn’t purchase insurance). Another fix will raise subsidies for low-income families seeking to buy insurance.

    In the original House bill that passed, healthcare expansion costs would have been paid for by an income tax surcharge on the “rich.” House liberals are pushing for that fix as well.

    So what is the counter-move? How do opponents of Obamacare stop this?

    Opponents cannot rely on liberal Democrats in the House who might balk at passing the Senate bill with just a “pledge” from 52 senators. I have no doubt House liberals, despite their skepticism, will fade under pressure from Pelosi and Obama. They will do their duty and pass the Senate bill, whatever their current posturing.

    Instead, the key to stopping the Pelosi-Reid plan lies with conservative or ?moderate? Democrats who voted for the healthcare bill the first time.

    There are 23 of these conservative-leaning Democratic House members who voted for Pelosi’s Obamacare back in November, which passed by just five votes, with 39 Democrats defecting to vote against the bill.

    All 23 of these congressmen who did vote for the Pelosi bill are extremely vulnerable.

    Opponents of Obamacare need to climb all over these 23 congressmen with TV ads and advocacy campaigns in their districts to get them to change their vote this time, to vote “no” to the Senate bill when it comes before the House.

    Voters need to say, “You voted for Obamacare the first time. But your district opposes it by 2 to 1. Now it is coming up for a vote again. Listen to your constituents and vote no. We don?t want Medicare cuts or premium increases or rationing of medical care. Don?t monkey with our healthcare. Vote no this time.?

    Since the House healthcare bill passed by five votes, much has happened and the political landscape has changed dramatically.

    The Massachusetts election of a Republican to Ted Kennedy’s Senate seat has sent shock waves through Washington. Every one of these 23 Democrats knows they will face an angry backlash in their districts if they vote for the Senate bill and go along with Pelosi-Reid plan to ram through Obamacare.

    I believe now is the time for opponents to act. The truth is that Obamacare is hanging by a thread.

    Opponents, if they move now, can drive a stake through its heart.

    Once these congressmen hear from their aroused constituents, they won?t be able to back Obamacare.

    As I mentioned, the Pelosi health bill passed the House by only 220-215. Nancy Pelosi knows she has no margin for error.

    If only a handful of these 23 congressmen change their vote under public pressure, the Pelosi-Reid plan is stopped and Obamacare is dead.

  • merryj1

    When making a pact with the Devil … the Devil does welch!

  • KBDay

    I’ve ranted about the AP citing the Mayo in Ariz. and about the prez pointing to Mayo as a stellar fiscal example in healthcare.

    Old news: Mayo hasn’t accepted Medicare in Jacksonville for quite some time.

    I’m betting these two aren’t the only places Mayo does that.

    This is just FYI and another example of old branded media not taking a single research step when it comes to statements by leftwingers.

    http://www.mayoclinic.org/becomingpat-jax/financial.html