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AMA Supports Government Healthcare...Doctors Must STAND UP for Patients!

By Dr. Lee Vliet and Dr. Richard Amerling

The AMA's support for government run healthcare "reform" appears to be a sweetheart deal with the Administration to protect its coding and business revenue under the guise of standing up for physicians and patients. Patients hear about the AMA support and think it speaks for all doctors. They do not realize the AMA represents only about 17% of practicing physicians, or that AMA membership has been steadily declining as physicians feel the AMA no longer shares their concerns about patient care.

Recent polls report that 66% of physicians oppose the House and Senate proposals that will fundamentally change the practice of American medicine, create another boondoggle, and cause massive budget deficits. Physicians know too well the restrictions on care and delays in government-run programs like the Indian Health Service and the VA. They feel that a massive government takeover of healthcare will drastically lower quality of care and choice of treatments and specialists, especially for the elderly.

In another recent poll, 45% of responding physicians said they would retire early or resign from medicine rather than participate in a government-run healthcare system. Think about it. Loss of nearly half of our physician supply would drastically alter both access and quality of care for all patients, regardless of what "insurance" you have!

Most physicians agree that some health insurance reform is needed to provide affordable coverage for those with pre-existing conditions and those who are between jobs. These problems affect about 5% of the American people, and can be rapidly and simply fixed with changes to existing state and federal regulations. We do NOT need a massive government takeover. The current Democratic proposals being forced on everyone threaten the very innovations and state-of-the-art services that have made American medicine the best in the world.

We do not have a "health care crisis." American patients receive excellent care with cutting edge diagnostics and treatment. Even those without health insurance receive excellent care - though their reliance on Emergency Rooms for primary care drives up overall costs to taxpayers. This problem is fixable with free-market solutions, but such solutions have been blocked by Democrats' total focus on government-controlled healthcare.

The majority of patients do not want the government telling them and their doctors what type of care they can have. The majority of physicians do not want the government telling them how to practice medicine, and destroy the very hallmark of the Hippocratic Oath: to do to the best of our ability and judgment those treatments that are in the best interest of our patients.

If majorities of patients and physicians do not want a government run health care system, what can we do to restore the physician-patient relationship that has served us well for two thousand years since Hippocrates?

Rather than leave practice, we think physicians must stand up for patients, and file for divorce from third party payers-government and private insurers. Physicians and patients must go back to the basics of contracting directly with each other for services at agreed upon fees.

We feel this approach is more rational, more efficient, more patient-centered, and more cost effective than having an inefficient, costly "Post Office" health care system micromanaged by government bureaucrats.

Divorcing third party payers returns us to the basics of our Constitution: individual physicians and patients having the freedom to decide contracts for services, and to choose what they feel are in their individual best interests.

Accepting payment directly from the insurer is a relatively recent aberration in the long history of the medical profession. Why are there no "crises" in cosmetic surgery, dental care, veterinary care, and legal services? None of these professions yielded to the temptation of direct third party reimbursement. Each of these professional groups sets fees for services based on free-market competition, with people free to choose those professionals and services that best meet individual needs and pocketbooks.

There was never a crisis in access to doctors' services in the pre-Medicare/Medicaid era. Physician fees were reasonable and when patients couldn't pay, doctors were free to adjust their fees and set up a variety of payment plans, or even provide services for free. None of these fee-adjustment options are "allowed" under today's Medicare and insurance regulations, but most patients don't know that.

Before Medicare days, doctors could and often did charge well-heeled patients a bit more, and charged less for those in financial difficulty. Pro bono, or free, care was a part of every practice. There was, and still is, competition between physicians for patients, so the free-market helped rein in excess charges, just as we see in other areas of the economy.

When patients paid their doctors directly, the physician-patient relationship was strong. Doctors worked exclusively for the patient and were their strong advocates. Medical care was used selectively and tailored to the individual's needs.

When the government and private insurers began paying doctors directly, and patients lost sight of actual costs, healthcare and the physician-patient relationship changed for the worse. Initially, doctors "accepted assignment" as a courtesy on an ad hoc basis. Medicare eventually required participating physicians to agree to this. Over the years, this practice became the norm.

Clearly third party payment may be convenient to patient and physician, but by insulating both from the true costs of care, it led to overutilization and massive increases in health care spending. Payers responded with the imposition of price controls and various schemes of micromanagement of medical decision-making such as managed care, and its new version, "pay-for-performance."

Mandated price controls fueled health cost inflation. Physicians had to see more patients per day to stay afloat. At some point, pushing to see more patients each day has to lead to compromised care. Just how "cared for" do YOU feel when your physician can only spend 3-5 minutes with you at an office visit because he or she how has to see 50-60 people a day to keep the doors open? No "quality improvement" measures can ever solve the problem of lost quality that comes with such high volume practice.

There is also the problem of government bureaucrats or private insurance clerks deciding what care you can have. In overriding, changing or denying what your doctor feels you need, they are effectively practicing medicine without a license!

This is highly relevant today. Baby boomers, who begin to turn 65 in 2011, will add another 76 million people to Medicare. Add to that the 30-40 million "uninsureds" to be covered by the Democrats' government run plan (i.e., combination of Medicare and Medicaid), and it is clear the system will quickly become overwhelmed. The current government system has tens of trillions of dollars of unfunded liability and is unsustainable. Adding more people to cover will dramatically hasten the implosion.

There is no way possible to have the same level of access and quality of service you have come to expect when you suddenly push another 120 million people into the same system, AND risk losing 40-45% of doctors.

What happens then to "universal coverage" if doctors won't participate? The public tends to think that physicians "divorcing" from third party contracts or "opting out" of Medicare is a negative action that would deserve righteous indignation, and justify a coercive response by the administration. Will doctors be compelled by law to accept the new plan?

Do YOU want a doctor who is forced to see you, or risks being sent to jail? Do you really think you will get the best care under such a scenario?

Physicians helped cause the current problems by agreeing to accept direct third party payment in the first place. A physician making a choice to "opt out" of third party contracts is a rational response to a man-made disaster. If this approach were more widely adopted, it would positively transform the health care landscape.

Large numbers of physicians choosing to opt out of the third party payment system, standing up for the sanctity of the doctor-patient relationship, would lead to lower utilization with huge cost savings. There is no more efficient model than direct pay since it eliminates the middleman for the majority of charges. Office costs are dramatically reduced once third party billing is abandoned. By setting their own rates, doctors will once again be in control of their time, and patient volume could decrease so that patients will be able to have longer appointments and quality time.

The doctor-patient relationship, arguably the essential ingredient for cure and comfort, would be strengthened. Quality of care would improve, again saving money. Once doctors stop being the "buffer" to deal with insurance issues, consumers will see the real costs and demand change. Real reform will follow swiftly. Consumers make wiser decisions when spending their own money.

Most consumers favor high deductible policies to cover major illnesses and hospitalizations, and would use tax-deductible medical savings accounts to pay for routine care up to the deductible. The marketplace has already responded by offering such policies at lower cost than standard low deductible policies.

The immediate objection to doctors opting out is that not everyone can afford to pay up front for care. The same argument could be made for veterinary, dental and legal care. The truth is that people still buy services they value. We have simply become accustomed to the current system for medical care, and don't want to give it up. Yet, many medical practices across the country have already gone "insurance free," and patients submit bills to their insurance carriers for reimbursement after they have already paid the physician.

Another frequent objection is that some patients will not go for needed care if they must lay out money. This is bogus. Current data from consumer driven health plans (CDHPs) such as health savings accounts, show that consumers do go for care, and they shop more wisely to be certain they are getting best value for their money. CDHPs are already lowering health insurance premiums by 4-10% at the same time standard plan premiums are rising.

Look beyond the political rhetoric to the ultimate goals of the current administration. Washington is really seeking universal taxpayer-funded and centrally controlled "health care." Practice will be directed (i.e. rationed) from federal committees using "practice guidelines" set by government panels.

Individualized care and medical confidentiality will be gone. The February 2009 Stimulus Bill requires your doctor to send your medical records electronically to the federal health "czar," beginning in 2014. Your medical records will be government owned and controlled. Your financial information and bank accounts will be directly accessible to the government. Your privacy will be toast.

Congress and the Administration will have attained their goal: all citizens will depend on the government for life and death decisions regarding their health. Doctors and other providers will all become government employees, subject to government mandates, guidelines and whims.

As physicians and patients, we see clearly that we can no longer trust organizations like the AMA or our political process to look out for our interests. The leadership in Congress and the President are committed to pushing "reform" on all of us, whether we want it or not.

The time has come for individual physicians to act in their own and their patients' interests, and to defend the medical profession they should hold dear. Physicians must declare independence from third party control in our offices and for our patients, particularly from state-run health care.

Physicians need to divorce the government and private third party payers, not leave medicine. Who will be there to stand up for the patients if physicians leave?

Healthcare "reform" is a subterfuge for control of our lives. We must stand up now. Our patients deserve strong physicians advocating for them and opposing government run healthcare. Physicians must take back medicine before it is too late.

Elizabeth Lee Vliet, M.D. is a women's health specialist who received her M.D. degree and internship in Internal Medicine at Eastern Virginia Medical School, then completed specialty training at Johns Hopkins School of Medicine. She received B.S. and M.Ed. degrees from The College of William and Mary in Virginia. Dr. Vliet is the 2007 recipient of The Voice of Women award from the Arizona Foundation for Women in recognition of her pioneering advocacy for the overlooked hormone connections in women's health. Dr. Vliet's books include: It's My Ovaries, Stupid!; Screaming To Be Heard: Hormonal Connections Women Suspect- And Doctors STILL Ignore; Women, Weight and Hormones; The Savvy Woman's Guide to PCOS.

Richard Amerling, MD, is a nephrologist practicing in New York City. He is an Associate Professor of Clinical Medicine at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center. Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is a member of the Association of American Physicians and Surgeons.