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 health care reform 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. 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

How We Define Death And The Future of Hospice.

Larry Beresford challenges the latest meme that hospice patients have declined in number recently. He notes that, among others, Tim Cousounis at Palliative Care Success and the Urban Institute's Howard Gleckman, who wrote a recent article for Kaiser Health News, have examined hospice enrollment and concluded the same thing. It is in decline.

The reasons they cite are varied but predictable: a bad economy makes doctors hesitant to refer profit-generating patients to hospice where the income derived from costly curative treatments naturally declines; Medicare rules require that a patient have less than 6 months to live before going into hospice and sometimes patients, particularly chronically ill ones, live beyond that time frame, a situation Medicare would like to avoid; and of course, the constant challenge of image that hospice faces as a place where one goes when they have "given up" continues to prevent ever-growing enrollment.

From Beresford's latest blog post:

I contacted a couple of leading hospice executives to ask them if the declining enrollments trend is true. One said that hospice patient census fluctuates up and down for all sorts of reasons, but that his agency's is up, after a sharp drop in 2008. But Samira Beckwith, CEO of the highly successful Hope Hospice and Palliative Care in Fort Myers, Florida, responds, "I think that everything [Gleckman] says in his article is true." One of the problems, she says, is that America's hospices still have not successfully communicated the idea that hospice care means "living" as fully and as well as possible until death comes. Instead, Americans have learned a little bit about hospice and believe it means "they have to die really soon if they say yes."

The problems of misunderstanding, misconceptions and mistrust of hospice care by people confronting hard choices at the end of life have been around throughout the history of hospice in America, even as the number of people receiving hospice care has steadily grown, up to 1.45 million in 2008. Physicians' reluctance to bring up the "H" word with their terminally ill patients has been well-documented. The second-guessing of hospices' enrollment decisions by Medicare has also intensified recently, but is not a new phenomenon. A similar round of government scrutiny occurred in the mid-1990s. And still the trends of the number of hospices, number of patients served and total Medicare outlays have pointed steadily upward since the first U.S. hospice opened in 1974 and since Medicare began paying for hospice care in 1984.

Beresford's conclusion is that perhaps this ebb in enrollment is really a reflection of market capacity:

The MBAs who run fast food or pharmacy chains are taught that when your company or your industry stops growing, it is already dying. But is that the right model for a service designed to promote compassionate, individualized, quality of life-promoting care for dying patients and their families? Shouldn't hospice's goal be to offer a meaningful option to all those who might need it and want it, and who might qualify, according to the rules of those who would pay for it, as being terminally ill -- rather than just continuing to grow? And if there is a current decline in referrals, given the recent proliferation and rampant competition of mom-and-pop hospice providers, particularly in certain metro areas and in the states of Alabama, Mississippi and Oklahoma, perhaps what's happening now is what the economists might call a necessary market correction.

I tend to disagree with Beresford and here's why: hospice is really the only option for patients who wish to die at home and so, as long as statistics continue to show that a majority of Americans wish to die at home (80%) and that most continue to die in facilities (75%) there's room for hospice to grow.

Whatever strides the hospice community has made in the past three decades or so of convincing society that the patient can decide where they die (and increasingly, when), the prevailing institutions in our culture - the church, the medical industry, and the state - haven't done much to change the tone of discussion about death. Only in Oregon, where the state population has had a long and in-depth conversation about end of life care (primarily because of the successful initiative to legalize assisted suicide) is there a more sophisticated understanding of end of life care options. I suspect that, as statistics in 2007 showed, that Oregon continues to lead the country in hospice enrollment. A couple of other factors that are working against hospice enrollment:

1. The rise of "pro-life" opposition to end of life choice (as conveyed through fear of "socialized" medicine, removal of artificial nutrition and hydration, end of life care planning (DNR, living wills, medical proxy designation), and aid in dying) and simple statistics that show the devoutly religious are more inclined to seek aggressive, futile care at the end of life are only one front that prevents society from viewing hospice as a healthy, life-affirming choice.

2. The medical industry has absolutely no incentive to direct terminal patients to hospice. Doctors are entrenched in a culture that, as Joanne Lynn says, puts patients on a "glide path" that involves aggressive treatment until death, as though death is a "failure" of medicine that can be cured. Doctors have only begun to be trained in medical schools for end of life care discussions (and continue to not be reimbursed for the necessarily lengthy discussions); palliative care is growing but still in its infancy; doctors tend to grossly over-estimate the time a patient has before death (hence delayed and briefer hospice enrollment); aggressive care is revenue for medical institutions and doctors; the conservative AMA and other medical associations (with the exception of many nursing organizations) have resisted society's call for greater improvements to end of life care. As well, advancements like 911, CPR, and the ability to lengthen a patient's life have prevented serious discussion about "quality of life." "Doing everything we can" to save a patient is the default, whether it lengthens the patient's life or keeps them comfortable - or not.

3. As we've seen during the year-long health care debate, the state has done little - either at the state or federal levels - to promote or legislate sound end of life care laws. I can think of only a handful of state laws that promote end of life planning. Veteran's Affairs, the largest health care provider in the US, has made commendable, great strides in meeting patient's needs and wishes in the last months of life but at the end of last year we saw them come under attack for distributing a planning guide, then termed the "death book." This noise, however illegitimate, makes institutions, health care providers, and doctors hesitant to discuss these issues.

In essence, the media and society have allowed fear-mongering and inaccurate accusations to shut down the end of life discussion.

The entire non-sensical circus that stemmed from the health care debate - death panels, the state's gonna euthanize you, etc. - has had an effect. The environment we're in at the moment (a political battle that has less to do with patient care than politics) has had a dampening effect on legislative efforts to enforce good end of life care planning.

The powerful Catholic church, a strong opponent of removal from ANH and of assisted suicide, is in a position where they must articulate nuanced and complicated arguments for hospice (an organization founded by the Catholic Cicely Saunders and long affiliated with the Catholic church) if they want to support hospice at all. For their political purposes, it is much better to push "all life is sacred" than "you're bound for a better place," both rhetorical constructs that sound true enough but work to As well, the church is firmly under the influence of a staunchly conservative leadership right now. And, as the second largest operator of hospitals in the US, they too have an interest in keeping patients in hospitals, receiving aggressive care. Their force and influence was proven during the health care debate.

And lastly, death just isn't what it used to be. Death used to mean the almost simultaneous end of a heart beat, breathing and brain function. In the past 30 or so years medicine has figured out how to maintain the first two indefinitely. And brain function, as we've seen with the cases of three young women - Karen Ann Quinlan (1985), Nancy Cruzan (1990), and Terri Schiavo (2005) - is increasingly considered not a suitable qualification for death.

But there is hope for hospice. Baby boomers are increasingly greying and, as they have changed every other institution their generation has moved through, end of life care is bound to be altered by their increasing need of it. As well, our health care system is not equipped for such a large influx of elder patients. The threat of economic destruction should be enough to push US society and government to reconsider how we care for those who are dying. Hospice will play a vital role in that reconsideration.

Malpractice Lawsuit Limits Overturned in Illinois.

The New York Times is reporting on overturn of the five-year-old law limiting medical malpractice lawsuit awards. To my mind, limiting awards is wrong - an overreach of the legislature into the judicial branch's territory.

Such limits, however popular among the Right (unnatural and rhetorical opponents of individual rights) do little to bring down the costs of health care in the US. It's a cheap ruse to distract from the real causes of our over-priced, ineffective system. Limiting awards is like putting a band aid on your sore, blistered heal because you refuse to give up the cheap shoes that are causing the damage. All it does is inhibit patients' rights in favor of the medical industry.

If lawsuits are a problem, perhaps we'd be best to understand why they occur (examine the cheap shoe) and stop penalizing the patient victims?

From the story:

The ruling came down as federal proposals to cap malpractice awards are receiving fresh attention on Capitol Hill. Republicans enthusiastically support the limits, and they are seen as a potential vehicle for restarting the stalled health care negotiations in Congress with bipartisan impetus. Neither the House bill that Democrats passed late last year nor its Senate counterpart included significant changes to medical malpractice regulations.

In a 4-to-2 ruling, the Illinois court wrote that the legislature, in enacting the 2005 law, violated the state Constitution’s separation of powers clause by imposing decisions that should be reserved for judges and juries. The law established caps of $500,000 for non-economic damages in verdicts against doctors and $1 million in cases against hospitals.

The decision armed opponents of such provisions with fresh ammunition, and held a particular sting for the American Medical Association, which has its headquarters in Chicago.

A statement from the American Association for Justice, formerly the Association of Trial Lawyers of America, said the decision illustrated “why federal efforts to place arbitrary limits on the amount injured patients receive won’t pass muster or fix America’s broken health care system.” Nearly 30 states have laws that limit non-economic damages, although the caps and circumstances for imposing them vary widely. According to theAmerican Medical Association, courts in 16 states have upheld the laws, while those in 11 states have overturned them.

The Real Reason the AMA Supports Health Care Bill.

The AMA's support for health care bill as approved by the Senate and House and now in reconcilliation has consternated both liberals and conservatives alike the past few months. Many, including myself, have supposed that the AMA sees the bill as benign to it's monopoly of health delivery in the US and therefore find it the least of its worries. Other concessions (like the disclusion of the public option which would have driven down prices) have made the bill easy for the industry to swallow. And because there's really no reform to the "reform," the industry supports this mandate of money to the medical industry. A mandate that comes with no real regulation of medical delivery, which the AMA has traditionally strongly opposed, being the teeth that have gnashed at reform and any bill of patients' rights in the past.

But a new article at the Chicago Tribune reveals the underbelly of the business of medicine and the financial gains the AMA will reap from this fake "reform" bill:

As Democrats tout the American Medical Association's endorsement of their health care overhaul, critics are pointing to their studious sidestepping of a little-known monopoly that sends millions into the trade group's coffers each year, saying it's no surprise the Democrats were able to gain the AMA's support.

The AMA, which this year reversed its long-standing opposition to such changes, holds the exclusive rights to the medical billing codes that doctors are required to use when they submit bills to insurance plans. They are the equivalent of a bar code for nearly every medical procedure, from transplanting hearts to tucking tummies and scoping colons.

It is a monopoly that critics say gets in the way of making health care less expensive and potentially more effective.

The arrangement is the product of a once-secret deal, struck in the early 1980s, that allowed the government to streamline billing procedures for its insurance programs by setting a single code set as the standard. Under that deal, the AMA maintains and updates the codes at no cost to the government, but generates millions each year selling the code books and software licenses to doctors and insurers.

Sen. Tom Coburn, R-Okla., an obstetrician, said doctors are "adamantly opposed" to the health care bills, and pointed to the code monopoly to explain the AMA's support.

"The [code] revenue's protected," Coburn said during debate on the Senate floor. "That's the revenue the AMA gathers from the payment system that continues to be fostered in this bill, which is their main source of revenue."

The original deal related only to Medicare and other government insurance programs. Since then, Congress has expanded the regulation to require the codes to be used in electronic billing transactions with private insurers. Some interpret the agreement to be revocable at any time through a simple rule-making process. Critics question whether the AMA can represent the interests of doctors while it relies on revenue that comes from a government-sanctioned monopoly.

AMA President Dr. James Rohack would not disclose how much the group raises from the codes each year, but he said that it is a portion of the $70 million claimed from sales of "books and products" in 2008. Membership dues raised $44 million for the AMA that year.

"There's an inherent conflict of interest," said Kathryn Serkes, director of policy at the Association of American Physicians and Surgeons, a competing doctors' group that has been challenging the code monopoly for years. "The AMA has a vested interest in keeping those codes going and keeping that system going because they're making money from those, tens of millions of dollars every single year."

Not a Dime of My Tax Dollars for That Brand Name Drug!

Dr. Scott Gottlieb has rallied the "America has the best health care in the world" crowd with his pro-doctor, pro-medical industry op-ed in today's WSJ.

Let me just say up front that it's hard to find something good in this health care bill already without making up poorly-framed arguments that those poor doctors and suffering medical corporations are going to have to, you know, adjust their practices. Had the industry better regulated itself over the past few decades, we wouldn't be where we are now. In a predicament where health care coverage is tapping the country's economy and still not reaching the majority of citizens effectively.

Of course the Wall Street Journal has a particular clientele, one that belongs to a class of society pampered by employer-paid stellar health care coverage. To claim that our system is currently working is to ignore the 45,000 deaths a year from inadequate health care access, or the 50 million Americans who have no health care at the moment. But this demographic never saw health care as a right, only as a commodity. If those poor bastards in a Texas had studies harder, pulled themselves up by their boot straps, they'd have decent jobs and decent health care coverage. In other words, not having health care is shameful and indicative of laziness. So goes the privileged reasoning.

Gottlieb makes the following claims in his piece:

While the AMA supports health care reform (and it's a dogged piece of legislation that has little to do with reform and all to do with appeasing the medical industry), various surgeon and specialty associations oppose it. That's because they will be hard pressed to pursue their specialties with the same abandon if they hope to accept Medicare payments. The legislation reigns in specialists - a group that has ballooned over the past few decades simply because the AMA has encouraged licensing of such specialists and because that's where the money is.

He protests the new powers given to Medicare and Medicaid to select cheaper services for patients, refusing to pay for name-brand drugs and treatments when generic will do. Of course the medical industry is up in arms over this. The overhead on name-brand services is what has made the industry such a rich and powerful loggerhead in medicine. Basic economics shows that Medicare and Medicaid can't afford - and shouldn't pay for - such overpriced services when cheaper ones are available.

Gottlieb argues that those who want to sue Medicare for not covering less expensive services will be discouraged from suing for them. To this I say: If you want a specialty services, pay for it. As women are being forced to do with the "specialty" service of abortion. For women the law of no coverage is simply religious discrimination but once mention that making economic decisions regarding other coverage is unfair and you get a gaggle of "free-market" conservatives claiming that Medicare has too much power. Let the patient pay for their extraordinary care if they think it will better help them. This isn't rationing. This is practicality in buying as far as I am concerned.

Gottlieb also criticizes what he calls incentives for independent specialists to merge or consolidate with other practitioners in order to keep costs down in delivery. This too is a practical concern. Independent specialists cost more, their overhead is not shared with other practitioners and therefor must come from somewhere. Until now that has been from Medicare and Medicaid or high-end insurance companies willing to pay more when the employer or patient pays more. If we want to cover all citizens and apply government regulation to government plans to reign in costs, we have to address the excesses. But if I were an independent specialist, I would be squealing too. My fat run is coming to an end.

Most of the cost-saving programs Gottlieb is criticizing are really demonstration programs, trials by Medicare to see what works. Instead of addressing the excessive costs of health care today, he is focusing on the wrong audience, the doctors, privileging their position - as all associations are of course apt to do - above that of the patient. But that's because Gottlieb is opposed to treating medicine as a right, affordable and accessible. Instead he wishes it to remain a commodity that has led to overspending.

He writes:

Regulation of medicine has always been a local endeavor, and it's mostly the province of medical journals and professional medical societies to set clinical standards. This is for good reason. Medical practice evolves more quickly than even the underlying technologies that doctors use. This is especially true in surgery, where advances flow from experimentation by good doctors to try different surgical approaches.

Sorry, but industry self-regulation is not regulation. As the medical industry has proven over the past decades, the great percentage of killers in the US have gone unaddressed by the big money innovators. Equipment and drug manufacturers have both pressured the public into pursuing boutique illnesses while heart disease and cancers have proven to go unchecked. That advancing innovation comes from small-time, independent surgeons is a fallacy. Innovation now, as Gottlieb calls it, is large corporations finding niches that will make them quick money.

The rallying cry worked for abortion has been "Not my tax dollars!"; how about using it to curtail excessive drug company profits and "innovations" in medicine that only address boutique treatments? When we start seeing advancements that change lives for those suffering the primary killers, preventative medicine that reduces costs and increase quality of life, and more affordable prices for all Americans, we can then discuss the excessive ways of the medical industry as innovative.

Gottlieb, a fellow at the notoriously conservative Free Enterprise Institute is approaching medicine from the medical industry's position. We've unsuccessfully tried that for decades. It's time we approach medicine from the standpoint of the patient.

Persecuted Doctors and Government Regulation of Health Care.

This cartoon image accompanies a post at Monty Pelerin's World of a 2000 article by a doctor about the "poor doctors" who are being unjustly subjected to government regulation. Of course the article is written by a doctor, a member of a profession which has for decades used its wealth, clout, authority, and professional associations to deny patients' rights and an overhaul of the medical industry. Doctor's gains of greater autonomy have been patients' loss, as is clear when the current state of care is assessed. Using doctors' authority to determine how the government should proceed in regulating delivery of medicine is like relying on the banking industry to look out for the public's financial needs. It doesn't work.

There's a lot of talk lately, spurred by the failed attempt by the Obama administration to reform the medical - and particularly the insurance - industry and regulate quality, affordable, accessible medicine for all, that doctors will be damaged by any regulation of "their" industry and practices. What has resulted from this tussle between patients' rights advocates, the medical industry, the church and the state is a failed bill that rewards the insurance industry with mandated payments for care. We're going the wrong way, progressive rightly claim. Yet another industry has been given a pass to discriminate, control, and financially thrive on the restrictions it exerts to the detriment of patients, particularly women, the poor, the elderly and the gay community.

What doctors claim is an entirely different thing. Despite the AMA's belated support for the plan - and why shouldn't they support a reform plan that essentially makes no reforms and brings more patients into their closed system - the association has historically worked to prevent any regulation of medicine delivery. As can be expected, their role is to advocate for doctors' rights, not patients'. Unfortunately, theirs is a position respected by the state and often the church.

A recent ad campaign by conservative doctors claims that health care reform will create a shortage of doctors, yet the AMA has long determined how doctors are trained - and how many. Any shortage of doctors will be in the general practitioner category because the association has protected and encouraged medical specialization. That's where the money is, where the prestige is. These new claims that reform or "socialization" in the form of government regulation will create a shortage is disingenuous from an industry that has worked to limit general practitioners. If you're a supplier, you want to keep your costs up by limiting access to your service. Since the advent of Medicare, the industry has kicked and screamed against further extending their reach in favor of specialization.

So these are the two prongs that the AMA has successfully worked in their fight against greater access for all citizens: prevent government regulation; and control the number of doctors available and in what discipline. It's a power play, pure and simple, which leaves patients' rights out of the equation.

Two weeks ago, I had the opportunity to communicate with the former chair of the AMA's Council on Ethical and Judicial Affairs. According to this doctor, patients had no rights because mandating such would infringe on doctor's rights. In other words, the doctor was the individual who should be left to decide what a patients receives. He actually likened a woman's need for a tubal ligation, unmet by providers in her area, to the challenges a consumer may have in finding collard greens for Thanksgiving or a new coat only sold at a department store the next city over.

This position, that care is not a right but a commodity, is abetted by religious cries for strict conscience clauses in health care reform. While I of course believe that individuals should be left to determine their own conscientious guidelines for their work, I do not think that such a decision should be allowed to institutions which receive government funding and are responsible to the entirety of society. You staff a doctor who won't inform, perform or refer a woman for abortions? You are discriminating against that woman's rights unless you provide a manner in which she can get the care she needs. Anything short of giving a woman a full range of options should never be allowed or funded by the government, to hell with institutional conscience, association ethics, government funding, church demands. If we are to develop a medical system that serves patients, we must do so without reserve or discrimination.

Our failed attempt to reform health care this year is yet another sad chapter in the demonstration of monopoly of medicine by the industry itself, left alone to regulate it's own responsibilities without the interference of government on behalf of the needs of patients.

Screaming that doctors will be forced out of medicine, that the AMA and doctors are being discriminated against, that government regulation of delivery of what should be considered a human right, is all unjustified claim of persecution. The "poor doctors" have been doing just fine for themselves. It's time to address the needs of the poor patients, as doctors' oath to the profession demands.

The AMA Monopolizing Patient Access to Other Providers.

From Earth Times, an article on how the Coalition for Patients Rights is working to ensure that patients can access cheaper, effective health care professions other than MDs. The AMA has a stranglehold on not only medical training but licensing, they represent a strong lobby that pressures states to qualify the scope of what other medical professions may provide. It's an old story, big pushy association works to make it's members only game in town.

Here's a clip from the article:

“There is an abundance of evidence that shows patients achieve equal or better health outcomes at lower cost to themselves and the health care system when they fully incorporate a range of health care professionals in their delivery system,” said Maureen Shekleton, PhD, RN, FAAN, a spokesperson for the Coalition for Patients’ Rights™ (CPR). CPR is comprised of more than 35 member organizations representing a variety of licensed health care professionals who provide a diverse array of safe, effective and affordable health care services to millions of patients each year.

There are numerous studies that show the high quality and cost-effectiveness of the care provided by professionals other than MDs/DOs. Collectively, these data substantiate the likelihood for more cost-effective care. Highlights include:

States are charged with overseeing each profession’s scope of practice and ensuring it is safe based on the education and training of the professionals. While research backs the clinical value of promoting access to health care providers besides MDs/DOs, state regulations can hinder access for patients. There are significant lobbying and advocacy efforts under way by some of the physician community to seek restrictions to the scope of practice of other health care professionals. For example, the American Medical Association (AMA) is actively working on advocacy documents that question, despite clear evidence to the contrary, the quality of care delivered by health care professionals who provide some of the same services as physicians.

“These efforts to lobby lawmakers and regulators are not only wasteful and divisive, but do a disservice to the public who have been benefitting from the care of these practitioners for decades,” said Shekleton. “Our health care system is already overburdened with shortages of qualified practitioners. As the oldest professional health care society in the United States, the AMA should be fostering a collaborative environment that meets the needs of patients, not looking to restrict the practice of qualified licensed practitioners and trying to prevent patients from seeing the provider of their choice.”

CPR members are dedicated to achieving optimal health outcomes for patients in a cost-effective way. As policymakers address how to control costs and expand insurance coverage, it will be critical to include all qualified health care professionals. “Ensuring and promoting the rights of patients to choose this kind of care is good for patients and it’s good for our health care system overall,” said Shekleton. “If we can be prudent with our financial resources and still ensure good outcomes for patients - it’s a win-win situation that policymakers should support.”

AMA and AARP Speaking Out About Health Care Reform.

From Jonathan Cohn at The New Republic:

This just in, from AARP and the American Medical Association:

WASHINGTON--As health reform reaches a critical juncture in Congress, AARP and AMA are joining forces to cut through the noise and focus on the benefits of health reform for older Americans who depend on Medicare and the physicians who care for them. Today, AARP and AMA are launching a national television ad that separates fact from fiction and highlights how health reform will improve Medicare by lowering prescription drug costs and making certain that neither government nor insurance bureaucrats come between Medicare patients and their doctors when making important health decisions.

This may sound like just another press release about just another interest group, or groups, launching ads on health care reform. But it's far more important than that. No bloc of voters spooks reform advocates more than senior citizens. The polls have shown seniors to be the most suspicious of reform. And with hundreds of billions of dollars in Medicare reductions on the table, confirming those suspicions isn't too hard for the opponents of reform to do.

That's why the White House and its congressional allies have worked so hard to court AARP and AMA (and why, at the end of the day, Congress will do something about the "Sustainable Growth Rate" adjustments to Medicare payments.) Interest group endorsements aren't always as important as they might seem, but veteran political operatives I know all seem to think these two groups really do have a lot of sway over the way seniors think.* Having them vouch for reform goes a long way toward undermining the death panel talk.

*Why? I'm not sure, but it may be that older Americans are from a generation more accustomed to taking political cues from elites and organizations they know.