Written by Dr. David McKalip, M.D.
On the 20th Anniversary of the fall of the Berlin wall (11/9/89), physicians of the AMA House of Delegates took a stand for freedom in medicine - and likely in America. As Washington politicians push a government and corporate takeover of medicine, physician representatives from around the nation stood up and gave marching orders to the AMA leadership.
Marching orders that they tell Congress and the American People what is acceptable, what is unacceptable and what is necessary for health system reform. It is now up to the AMA Board of Trustees to follow the will 17% of America's doctors represented in the AMA House. If they don't do so, they will forever damage the credibility of the AMA as a trusted organization that stands up for patients and their doctors. It will then be necessary for America to turn to representatives of the 83% of doctors that are not members of the AMA - a number that could grow.
Just as the Berlin Wall separated individuals living under state control from those living under freedom, the Washington takeover will stand as a corporate and government barrier between patients and doctors. Congressional plans will also substantially increase the cost of medical insurance, force more people into Medicaid which is taken by too few doctors, limit the choice of health financing products and punish doctors who provide the necessary care patients expect to receive. After paying their premiums or trusting a government insurance option, they will find that their doctor has been placed on a budget. They will find that their doctor will be punished financially and professionally if they go over the budget set by Congress and insurance companies. They will also be punished if they provide care that is not approved by committees. These punishments will break the most critical bond in the patient-physician relationship - trust in your doctor.
But there is hope that the AMA will now stand up and refuse to allow that Berlin Wall of medicine to be built. The directive from the AMA House to the Board was clear: actively and publicly advocate for patients based on specific AMA policies that emphasize freedom. They will now be required to tell Americans how so many of the bad proposals will penalize doctors who care for patients and oppose these provisions in legislation. For instance, Congressional proposals passed in HR 3962 and the Senate Version (HR 3590) state that the Secretary of Health and Human Services will be granted broad powers to penalize doctors who don't report private medical data to the public. Such public reporting has been shown to lead doctors to avoid the sickest patients since they would get a bad government report card. The AMA will be required to publicly state how doctors should not be punished for going over budget - or for higher "utilization" in bureaucratic parlance. Doctors should not be penalized for ignoring committee created "performance" measures that have actually been shown to hurt some of their patients. Patients should not be denied the right to go to the best hospital or facility in town only for the reason that a group of doctors happen to own it. Pay of doctors providing vital cancer, heart, brain, spine, joint and other medical care should not be cut simply to give more money to other specialists in primary care.
More importantly, they are now required to advocate for tort reform as a common sense way to cut defensive medicine costs. They must also actively and publicly tell the American people a sad and hidden truth: the government denies their rights to privately contract with any doctor they want. For instance patients are now denied the right to pay an extra $25 or so above Medicare rates simply to see a doctor who won't make them wait for an hour to see a nurse for ten minutes and the doctor for three minutes. They are denied the right to leave a Medicare system that may not cover all services and doctors they want without losing all their hard earned Medicare benefits to pay that doctor. In fact this will get worse under HR 3962 as a patient that sees any doctor who leaves Medicare for ethical or other reasons will not be allowed reimbursement (to the patient) for hospitalization, tests or treatments from Medicare! The new AMA marching orders state that they must support publicly and actively the right to privately contract between patients and doctors to overcome this Congressional denial of patients rights. Sadly, an amendment to do this was defeated by a Democratic party-line vote hours prior to the final vote on HR 3962.
As Americans remember how freedom was brought to Berlin when the wall was brought down by the efforts of Ronald Reagan, let us resolve not to allow that wall to be built now between doctors and patients. The AMA leadership has the chance to stand up now for patient freedom and against government and corporate intrusion that penalizes doctors who provide care in the best interest of their patients. If they do this, they will be known for fighting for patients, the medical profession and will secure the trust of the American people in the AMA name. If they don't, then Americans must place them with all the other special interests who most value their seat at the table with other politicians. They will know the AMA only as an arm of the state and guardian of the Medical Berlin Wall the state has built.
Dr. McKalip is a private practice brain and spine surgeon in St. Petersburg Florida, member of the Board of the Florida Medical Association and Immediate Past President of the Florida Neurosurgical Society and worked in the AMA HOD to pass these directives to the AMA Board.