Tuesday, June 22, 2010

The AMA's "Free-Market" Legacy.

Well here's a fascinating little tidbit from June 9 that I'm slow to come across, below. A new study shows that a majority of AMA members opposed the association's position on health care reform. Now, why would doctors support the expansion of Medicare to cover uninsured patients and not a professional association like the AMA? Why would the AMA prefer "private means" of expanding coverage to the uninsured? It's an easy question to answer when you look at the traditionally conservative, paternalistic nature of the organization and the field. I know that I'm over-generalizing here but the study proves my point that the AMA is grossly more "free-enterprise," and conservative than it's members. (Kind of recalls to mind the nature of the debate between the USCCB and it's unabiding "adherents," the CHA, women religious, and lay members.)

This report makes me pull out an article that the former chair of the AMA's Ethical and Judicial Affairs sent to me when I asked him about health care as a human right. It was published by the Cato Institute in 1998, and alleges that, "The right to health care is perhaps the most widely accepted of all welfare rights." Indulge me while I include the important following paragraph:

In the end, however, that argument is flawed in the same way as any other appeal to the notion of positive liberty. Obtaining treatment for illness or injury is obviously a human need, but hardly a more important need than obtaining food or shelter. As with all other goals, people need the freedom to weight it against other goals and to choose the means of obtaining it. But they cannot define their freedom in defiance of the facts, or at the expense of the freedom of others. Illness and injury are natural risks inherent in life, and all the means of dealing with them -- from aspirin, to open-heart surgery, to health maintenance organizations -- must be produced by human effort to which no one can have a right without the producers' consent.

The producers here, of course, are doctors and the medical industry. How dare sick people expect others to meet their care needs? Let them sink or swim in the free market where medicine should be a commodity and "natural risks inherent in life" should be carried for the sake of liberty.

The report:

Researchers at Mount Sinai School of Medicine have found that the majority of physicians and members of the American Medical Association (AMA) opposed the AMA's position on coverage expansions--the most contentious issue in the recent health care reform debate. The data are published in a letter in the June 9th issue of the New England Journal of Medicine.

In the 2009 debate, the AMA opposed Medicareexpansions and proposed coverage of the uninsured primarily through private means. The researchers found that only 12.5 percent of all physicians and 14.2 percent of AMA members who participated in the survey supported the AMA's position on insurance coverage expansions. Salomeh Keyhani, MD, MPH, Assistant Professor of Health Policy, and Alex Federman, MD, MPH, Assistant Professor, Medicine, Mount Sinai School of Medicine, co-authored the study.

"Our survey indicates that most physicians and AMA members oppose the AMA's views on coverage expansions," said Dr. Keyhani. "The AMA is a highly visible organization that is presumed by many to represent physicians' opinions on various issues. However, there appears to be a discrepancy between the AMA's platform, the beliefs of its members and the views of physicians nationwide."

Mount Sinai researchers used the AMA Physician Masterfile to survey 5,157 physicians. The researchers secured a 43.2 percent response rate. There were no significant differences in response based on specialty, practice type, or geography. Physicians that were most supportive of the AMA's position were doctors of osteopathy (16.5 percent), physicians whose income was based on billing (16.1 percent), and physicians in rural areas (16 percent). The lowest level of support came from female physicians, with only 7.9 percent supporting the AMA's platform. Physicians who back the AMA's position were more likely to be younger, male practice owners in nonmedical or nonsurgical specialties such as anesthesiology, pathology, or radiology, fields that typically involve less patient interaction.

Respondents to the survey were asked to indicate their support on key issues, including the public option, expansion of health insurance through private means, and support for a proposal that would allow adults 55- to 64-years-old to buy into Medicare. were considered to be in support of the AMA's position if they agreed with private expansions only and opposed the expansion of Medicare.

Provided by The Mount Sinai Hospital

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December 16, 2010 at 9:28 PM  

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