In a letter to Senate Majority Leader Harry Reid (D-NV), AMA Executive Vice President Michael Maves, while withholding endorsement, expresses support for many features of the bill:

1. Huge premium increases for some. The AMA supports guaranteed issue, modified community rating, removal of limits on pre-existing conditions, and “nondiscrimination based on health status.” All of these will increase premiums to young, healthy, responsible individuals, and will basically outlaw true insurance, which offers premiums based on risk. Young, healthy workers will be overcharged to subsidize older people who have had much more time to increase their earning ability and to accumulate assets. This will rob the young and limit their ability to get ahead. A healthy 25-year-old could see his premiums triple (Business Journal 11/6/09).
2. Wealth redistribution; decreasing incentives to work. Refundable tax credits based on income to help cover premiums are a form of forcible wealth redistribution. The arbitrary income thresholds translate into very high marginal tax rates on those striving to pull themselves out of poverty by working harder or gaining skills.
3. Limiting choices of seniors. The plan would reduce “overpayments” to Medicare Advantage plans, with “overpayment” being undefined. While AAPS takes no position on the desirability of Medicare Advantage plans, the fact is that some 25% of seniors have chosen them for the richer benefits that they offer. The result of making these plans less attractive or available will be to increase the demand for Medigap plans sold by AARP—the AMA’s partner in advertising for “reform.”
4. Limiting choices for everyone. The health insurance exchanges, which are supposed to “offer more affordable choices,” are modeled on the Massachusetts Connector, which has the effect of restricting choices and increasing cost through expensive mandates.
5. Expanding dependency on Medicaid. Provisions to “enhance” Medicaid coverage mean expanding Medicaid coverage, placing more burden on states that are already being bankrupted by it. Being forced onto Medicaid restricts patients’ options to the diminishing number of physicians willing to accept Medicaid.
6. Increasing costs, and shifting resources away from sickness care. Coverage for “prevention and wellness initiatives” without copayments or deductibles will guarantee increased costs, by removing the most effective utilization control mechanism, with little to no proven benefit. It will also increase incentives to shift efforts away from the more difficult work of caring for the sick.
7. Decreasing physician autonomy. There is no evidence that spending $1 billion on “comparative effectiveness research” will “enhance patient-physician decision making about treatment options.” In fact, it will increase pressure on physicians to conform to government-approved protocols.

Even in its proposed “improvements,” the AMA accepts, in principle, the central planning, price controls, and expanded government intrusions in the bill. It is apparently willing to accept the abolition of true insurance, a virtual government takeover of the practice of medicine, and the socialist principles of wealth redistribution and compulsory “insurance” for a small increase in physician payments and a slight easing of the most onerous regulatory requirements.

The AMA has not even taken notice of some of the very worst provisions of the bill, noted by AAPS physicians and others in our virtual reading room.

The “administrative simplification” provisions—apparently the huge new regulatory apparatus created by HIPAA ostensibly for this purpose isn’t enough—will likely provide more profit-making opportunity for the AMA to produce codes and compliance materials.

Additional information:

• LISTEN TO OUR WEBCAST TONIGHT, THURSDAY DECEMBER 3.
• “’Max Tax’ (Baucus Bill) Hurtling Through Congress,” AAPS News of the Day 9/28/09.