Tuesday, June 22, 2010
The AMA's "Free-Market" Legacy.
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.
In the 2009 health care reform debate, the AMA opposed expansions 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 through private means, and support for a proposal that would allow adults 55- to 64-years-old to buy into Medicare. Physicians 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
Reigning In The Cost of Futile Care.
Both of these patients are composites of people we see at the hospital every day, and they demonstrate why it will be so hard to rein in healthcare spending. Americans have spent the last several decades hearing that all you have to do is be a little assertive to get top-of-the-line treatment. They have had prescription coverage through their health insurance for so long that they have trouble understanding why I won't prescribe a convenient Z-Pack of antibiotics (at a cost of $60 or so) instead of amoxicillin, which they have to remember to take three times a day (at a cost of about $4). Websites and magazines tell them that if the doctors say a condition is untreatable, they should shop around for a specialist, or bully the doctor into trying an experimental treatment and the insurance company into paying for it.