AMA's position on coverage expansion was inconsistent with the views of most physicians

Jun 10, 2010

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 debate, the AMA opposed Medicare 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 insurance through private means, and support for a proposal that would allow adults 55- to 64-years-old to buy into Medicare. were considered to be in support of the AMA's position if they agreed with private expansions only and opposed the expansion of Medicare.

Explore further: Experts call for higher exam pass marks to close performance gap between international and UK medical graduates

Provided by The Mount Sinai Hospital

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User comments : 47

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JerryPark
5 / 5 (2) Jun 10, 2010
I thought it was well known that the AMA did not represent and was not in line with the views of most physicians. Only a small fraction of practicing physicians even belong to the organization.
marjon
4 / 5 (4) Jun 10, 2010
I thought it was well known that the AMA did not represent and was not in line with the views of most physicians. Only a small fraction of practicing physicians even belong to the organization.

It was well known by those who cared but suppressed by the socialist media who want to completely nationalize health care.
freethinking
3 / 5 (4) Jun 10, 2010
Listen people, the most reporters are progressives. Progessives by their very nature believe that the ends justifies the means. Lying, hiding the truth, etc, are all part of the game.

The AMA is run by progressives, so who do they support.
The Media is run by progressives so you expect them to tell you that the AMA doesn't represent most doctors?
gwargh
5 / 5 (1) Jun 10, 2010
"AMA's position if they agreed with private expansions only and opposed the expansion of Medicare."

How many of them supported Medicare expansion?
AmericanMedicalAssociation
3.7 / 5 (3) Jun 10, 2010
None of the survey choices accurately describe AMA policy and it's unclear exactly what questions were asked in this year-old survey. This survey is inconsistent with an earlier NEJM piece on the topic by the same authors. The bottom line is that AMA supported health system reform based on policies created by the AMA House of Delegates through a democratic process including physicians and medical students from every state and every qualifying medical specialty. AMA has long supported a uniquely American health care system that includes both private insurance for the majority and a robust public safety net for vulnerable patients. The new health care law expands coverage to millions more Americans through both public and private insurance.
marjon
1 / 5 (1) Jun 10, 2010
None of the survey choices accurately describe AMA policy and it's unclear exactly what questions were asked in this year-old survey. This survey is inconsistent with an earlier NEJM piece on the topic by the same authors. The bottom line is that AMA supported health system reform based on policies created by the AMA House of Delegates through a democratic process including physicians and medical students from every state and every qualifying medical specialty. AMA has long supported a uniquely American health care system that includes both private insurance for the majority and a robust public safety net for vulnerable patients. The new health care law expands coverage to millions more Americans through both public and private insurance.

What percentage of MDs in the USA are AMA members?
Skeptic_Heretic
5 / 5 (2) Jun 11, 2010
What percentage of MDs in the USA are AMA members?
From what I understand it's about 25% of the total. Tough number to get though as there isn't really a count of practicing MDs and ODs overall with which to compare the AMA membership number, plus AMA membership doesn't require a doctorate or have a requirement of current practice.

From the poster AMA:
AMA has long supported a uniquely American health care system that includes both private insurance for the majority and a robust public safety net for vulnerable patients.
As far as I'm aware this is the exact reasoning for the AMA stance. Although I disagree with the bill itself I don't disagree with the AMA stance.
marjon
2.3 / 5 (3) Jun 11, 2010
The AMA's stance harkens back to the days of the guild.
Guild's protect themselves from competition and instead of the medical industry becoming more competitive and efficient, they promote insurance and government protections (state licensing, limited medical schools, government programs, etc).
Those segments of the medical industry not covered by insurance have demonstrated efficiencies and lowered costs and high quality.
It is unfortunate the government gets into the business of protecting certain industries as it stifles progress, costs much more money, takes power away from customers and puts it in the hands of politicians and bureaucrats.
Skeptic_Heretic
3 / 5 (2) Jun 11, 2010
Guild's protect themselves from competition and instead of the medical industry becoming more competitive and efficient, they promote insurance and government protections (state licensing, limited medical schools, government programs, etc).

Your understanding is incorrect. Doctors spend more time fighting with insurance industries than the patients do. There's no collusion between doctors and payors beyond contractual negotiations of dollar amounts for services.

Marjon, there's a recurring theme in your posts. It is "everyone is out to steal me pot of gold". Are you a leprechaun?
marjon
2.3 / 5 (3) Jun 11, 2010
" MGI found that the overriding cause of high U.S. health care costs is the failure of the intermediation system � payors, employers, and government � to provide sufficient incentives to patients and consumers to be value-conscious in their demand decisions, and to regulate the necessary incentives to promote rational use by providers and suppliers. "
http://www.mckins...port.pdf

Because of third party payors, doctors and other participants in the system receive higher compensation. Why would they want to deal with thousands of customers (patients) when they can eventually get paid by insurance companies who have less interest in value for the cost?
It is not surprising AMA supports insurance.
Skeptic_Heretic
3 / 5 (2) Jun 11, 2010
Why would they want to deal with thousands of customers (patients) when they can eventually get paid by insurance companies who have less interest in value for the cost?
It is not surprising AMA supports insurance.
The AMA supports insurance because insurance promotes regular checkups. Regular checkups avert the need for catastrophic care giving when it's far too late. This is like taking your car to the mechanic on a yearly basis. Getting your brakes checked before the pads run down to the rotors prevents unnecessary accidents and expense. Then again, you probably think that's just a scam to sell wiper blades.

Most doctors would rather deal with patients directly and can give cheaper care with no insurance company intermediary. Insurance companies protect doctors from malpractice, that is why some favor insurance. Again I assert, your understanding is incorrect.
marjon
2.3 / 5 (3) Jun 11, 2010
"the American Medical Association, which operates in a manner very similar to that of the medieval guilds.[5] The AMA serves to reduce the number of people who can practice medicine, and thereby increases the cost of medical treatment beyond what it would be in a competitive market."
""Professional licensure laws have long made the provision of most personal health services the exclusive province of physicians. Obviously, such regulation limits consumers' options by forcing them to use highly trained, expensive personnel when other types might serve quite well."[6]"
"The AMA has engaged in extensive litigation charging chiropractors and osteopaths with the unlicensed practice of medicine, in an attempt to restrict them to as narrow an area as possible. Chiropractors and osteopaths in turn charge other practitioners with the unlicensed practice of chiropractic and osteopathy."
http://mises.org/..._ednref5
marjon
2.3 / 5 (3) Jun 11, 2010
"Doubtless most members of the AMA believe that such requirements work to the consumer's benefit by protecting him from substandard medical care, but this only shows the extent to which interest groups subconsciously conflate their own interests with those of society as a whole."
http://mises.org/..._ednref5
"causes of the present crisis in medical care, namely, its runaway cost,
which the Clinton plan is intended to address, can all be subsumed under one
essential heading: the government’s violation and/or perversion of the
individual’s actual, rational right to medical care."
"It cannot be stressed too strongly that this system of medical insurance
contains essential features of socialized medicine. And that, as we shall see, is
why our problems in connection with medical care have gotten progressively
worse since World War II, as the present system of medical insurance was
extended and people became more and more acclimated to it."
http://www.google...eb&c
marjon
2.3 / 5 (3) Jun 11, 2010
"A leading socialist feature of the system is that the typical wage earner has
been led to regard medical care as essentially free, either completely free or
virtually completely free, or, at most, 80 percent free after a modest deductible
and then completely free after a relatively modest maximum limit on his
own outlays. Thus, the psychology of the average American worker in relation
to the cost of medical care has become the same as if he were living under
communism. For all practical purposes, medical care comes to him simply
according to his need for it. This situation is both based upon and reinforces
the perverted notion of the right to medical care as a right divorced from
considerations of what one has earned and can afford to pay and of the
willingness of suppliers to satisfy one’s need out of regard to their own
financial self-interest."
http://www.google...53YSTMbo
Skeptic_Heretic
3 / 5 (2) Jun 11, 2010
And back to quote mining and talking about socialism with no point of your own.

You just can't stand to not have an argument can you? I'm not playing this time, I've addressed all of your points and your chair of argument is now legless.

Just an FYI: Chiropractic and Osteopathic care have both been shown to provide little to no benefit and do not lend to wellness or healing of an individual. Effectively you'd get the same level of medical care from a prostitute who gives happy ending massages.
marjon
2.3 / 5 (3) Jun 11, 2010
Chiropractic and Osteopathic care have both been shown to provide little to no benefit and do not lend to wellness or healing of an individual

Shown by whom, you?
I know many people who have been helped by chiropractors when MDs could do nothing, and a DO we had did much more than any MD to diagnose an allergy for my son.
Skeptic_Heretic
3 / 5 (2) Jun 11, 2010
Shown by whom, you?

http://www.scienc...69008d13
and http://journals.l...c.5.aspx

Moist studies have shown that patients improve initially when treated by either field but shortly thereafter the treatments provide no net benefit and reoccurance of issue is high without formal medical treatment.

In short both provide a placebo effect but no actual treatment.

How many of those friends of yours (uncontrolled anecdotal evidence) still have to visit a chiropractor regularly? The placebo gets you an initial good feeling about the procedure, so you think it works and you return repeatedly becomming a sack of money.
marjon
2.3 / 5 (3) Jun 11, 2010
The problem with an MD 'fix' was back surgery requiring months of recovery time not available.
A periodic treatment by a chiropractor enabled my father to work on his farm.
The allergy MD couldn't ID the allergy and had no idea what to do except poke allergens into my son and prescribe drugs.
The DO proscribed a very special lab tests requiring blood to be collected during the next attack.
The DO had an interest in finding the problem. The allergy MD wanted to push pills.
That is MY data and as a customer, I respond to my experience and judgment.
freethinking
3.3 / 5 (3) Jun 11, 2010
SH, bad you. I agree with your statement about chiropractors. :( Does that mean I'm now joined with you as an progressive athiest? I know for a fact that chiropractors are trained on how to get people to visist them regularly and how to get the most money out of a patient as possible.
marjon
2.3 / 5 (3) Jun 11, 2010
SH, bad you. I agree with your statement about chiropractors. :( Does that mean I'm now joined with you as an progressive athiest? I know for a fact that chiropractors are trained on how to get people to visist them regularly and how to get the most money out of a patient as possible.

MDs prescribe placebos to make people feel better. Is that ethical?
If anyone who provides a product or service that does not meet to your satisfaction, why would you return?
Skeptic_Heretic
3 / 5 (2) Jun 12, 2010
Then go ahead and keep forking over money to a charletan, I care not how you burn your wealth Marjon. Feel free to have someone slap you around and manipulate your bones (with no medical training) until they accidentally snap your neck.
marjon
2.3 / 5 (3) Jun 12, 2010
Then go ahead and keep forking over money to a charletan, I care not how you burn your wealth Marjon. Feel free to have someone slap you around and manipulate your bones (with no medical training) until they accidentally snap your neck.

Free markets are great. People, not the state, can choose what is best for them.
Skeptic_Heretic
3 / 5 (2) Jun 12, 2010
Free markets are great. People, not the state, can choose what is best for them.
Problem for your statement is most people are wholly ignorant of reality, including you. Fre4e markets are awesome for companies that have no morals or ethics. Free markets are like casinos. Better hope you win. No one will comp you a meal if you're broke in the free market.
marjon
2.3 / 5 (3) Jun 12, 2010
Free markets are great. People, not the state, can choose what is best for them.
Problem for your statement is most people are wholly ignorant of reality, including you. Fre4e markets are awesome for companies that have no morals or ethics. Free markets are like casinos. Better hope you win. No one will comp you a meal if you're broke in the free market.

That's where churches and mutual aid societies stepped in to provide charity. The downside for the recipient of such charity was he had to look the people in the eye who provided such charity and might possibly feel a sense of gratitude instead of entitlement.
Free markets are like casinos. Better hope you win.

Free markets provide opportunities for those who are willing to work and meet the needs of their customers. Any gamble is due to fickle politicians who keep changing the rules.
Skeptic_Heretic
3 / 5 (2) Jun 12, 2010
That's where churches and mutual aid societies stepped in to provide charity.
Yeah because that's what we want, less secular government providing for people and more fundamentalist ideology conning people into joining their ranks. Too bad, not buying it.
Free markets provide opportunities for those who are willing to work and meet the needs of their customers. Any gamble is due to fickle politicians who keep changing the rules.
Free markets don't have rules by definition. Again, study up before you spew bullshit.
marjon
2.3 / 5 (3) Jun 12, 2010
Free markets don't have rules by definition

Yes, they do. No one can force anyone to buy or sell.
Skeptic_Heretic
3 / 5 (2) Jun 12, 2010
Free markets don't have rules by definition

Yes, they do. No one can force anyone to buy or sell.

Unless they are a sole distributor of a necessary commodity.
marjon
2.3 / 5 (3) Jun 12, 2010
Free markets don't have rules by definition

Yes, they do. No one can force anyone to buy or sell.

Unless they are a sole distributor of a necessary commodity.

This can happen in one of two ways:
1. Force is used by the state to protect the distributor. (NOT a free market.)
2. The sole distributor provides the commodity at a price that no other company can beat. (A free market.)
Skeptic_Heretic
3 / 5 (2) Jun 12, 2010
That cannot happen unless force is used. It is a free market creating the opportunity for others to meet the demand.

If I'm the only doctor in town and you're bleeding to death who's going to fix you up if I refuse to treat you for free?
marjon
2.3 / 5 (3) Jun 12, 2010
That cannot happen unless force is used. It is a free market creating the opportunity for others to meet the demand.

If I'm the only doctor in town and you're bleeding to death who's going to fix you up if I refuse to treat you for free?

If you refuse, who will ever seek out your services again?
Unless you use force to keep other doctors out of town, another doctor can take your business. Or, the citizens of the town can take first aid and contract with a neighboring clinic or hospital for medical services.
What if the government health service deems your town is too small to have government doctor. What do you do when you are bleeding to death?
Skeptic_Heretic
3 / 5 (2) Jun 12, 2010
If you refuse, who will ever seek out your services again?
Everyone who wants to live.

Unless you use force to keep other doctors out of town, another doctor can take your business. Or, the citizens of the town can take first aid and contract with a neighboring clinic or hospital for medical services.
Ok what laws prevent me from using said force? Free market has no rules, remember?
marjon
2.3 / 5 (3) Jun 12, 2010
Ok what laws prevent me from using said force? Free market has no rules, remember?

I said free markets do have rules, freedom to buy or sell. If you use force to prevent competition, the competition has the right to use force to protect his rights in the market.
So, feel free to force others to buy from you, but you will not be in business for long. You will be dead or have no customers.
Skeptic_Heretic
3 / 5 (2) Jun 12, 2010
So, feel free to force others to buy from you, but you will not be in business for long. You will be dead or have no customers.
Who's going to stop me? No government interference, remember? Killing is still illegal. You're not allowed to kill me, but I can force you to die by with holding services unless you pay.

This is the reason why free markets don't work. Cornering the market can be fatal.

And regardless of what you said free markets have, the definition is "a market that is entirely unfettered by rules or regulating bodies".

Once you have rules, the market is no longer free.
marjon
2.3 / 5 (3) Jun 12, 2010
Free markets have rules. Buyers are free to buy, or not and sellers are free to sell, or not.
If you are an AMA doctor who swore a Hippocratic oath and fail to save someone for not paying, you violate your oath and risk losing accreditation as an MD and will not be able to practice anywhere.
You are free to do so and suffer the consequences of your actions. One consequence is a civil suit demanding compensation.
Of course you could be an 'uncertified' doctor or a quack and therefore not even a real doctor by your own definition. Then your little story is specious.

Your definition of a 'free' market is wrong: people are free take whatever they want by force. That is not a market and it is certainly not free.

Murder is illegal. Self defense is not illegal.
marjon
2.3 / 5 (3) Jun 12, 2010
"a genuine free-market economy:
All means of production are privately owned.
The use of these means of production is under the control of private owners who may be individuals or corporate entities.
Consumer demand determines how the means of production will be used.
Competitive forces of supply and demand determine the prices for consumer goods and the various factors of production, including labor.
The success or failure of individual and corporate enterprises is determined by the profits or losses these enterprises earn, based on their greater or lesser ability to satisfy consumer demand in competition with their rivals in the marketplace.
The market is not confined to domestic transactions and includes freedom of trade and the free movement of people internationally.
The monetary system is based on a market-determined commodity (for example, gold or silver), and the banking system is private and competitive, neither controlled nor regulated by government. (cont)
marjon
2.3 / 5 (3) Jun 12, 2010
(cont)
Government is limited in its activities to the protection of life, liberty, and property.
By this definition neither the United States nor any other country in the world is currently a free-market society.

"It is important to note that the interventionist system represented by these seven points (see ref) can only be implemented through violent means. "
"What is most striking is the voluntary nature of truly market-based social arrangements. Violence or its threat is reduced to a minimum, and the individual is left at liberty to live his own life and improve his circumstances through free association with others."
http://www.thefre...t-state/

Why do you socialists want to violently inhibit people from freely associating with each other?
Skeptic_Heretic
3 / 5 (2) Jun 13, 2010
If you are an AMA doctor who swore a Hippocratic oath and fail to save someone for not paying, you violate your oath and risk losing accreditation as an MD and will not be able to practice anywhere.
Actually the Hippocratic oath is to do no harm, it says nothing about obligation to assist.
You are free to do so and suffer the consequences of your actions. One consequence is a civil suit demanding compensation.
And under what law will you argue that civil suit? Maybe this one?
sellers are free to sell, or not.
Nope, probably not.
Why do you socialists want to violently inhibit people from freely associating with each other?
First you define mercantilism and state it is a definition of the free market, ha. Then you ask why SOCIALISTS want to violently inhibit people from freely associating or being SOCIAL. Are you retarded?
marjon
2.3 / 5 (3) Jun 13, 2010
"I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism."
http://www.pbs.or...ern.html

No need for a 'law' for a civil suit. The 'law' is the contract.
In the 1840s western USA, mountain men would come down from the mountains every spring for a Rendezvous. Fur buyers and merchants would meet the trappers and trade. They didn't need a government agency to create or engage is such activity.
Skeptic_Heretic
5 / 5 (1) Jun 13, 2010
And no one man was capable of having the only access to a resource.

Free markets work when resources appear infinite though difficult to obtain. You're a creationist, you think "god will provide". He won't, resources are not infinite. He who dies with the most toys, dies. That's the only rule in a free market.

You say no one can use force in the free market, then you tell me I'll be forced to sell if I refuse to.

Again, you don't know what you're talking about.
marjon
1 / 5 (2) Jun 13, 2010
Free markets work to CREATE resources.
Free markets provide incentives for entrepreneurs to meet the needs of their customers in creative ways.
The government and big businesses didn't think people would want a personal computer.
I don't understand why people want a TV with a 3" screen, but they do and entrepreneurs are providing such products.
You say no one can use force in the free market, then you tell me I'll be forced to sell if I refuse to.

If you, as a doctor, who swore and oath to save people, refuse to live up to your voluntary oath, the organization (a voluntary organization) that certifies your status in society as a doctor has a contractual obligation to withdraw their certification.
That is the nature of contracts and respecting private property and voluntarily associations.
Auto makers are not required to test their cars with the private IIHS, but they do and they modify their cars to pass their tests. Why? To sell more cars that customers want.
marjon
1 / 5 (2) Jun 13, 2010
The AMA and the ABA would gain much more respect if they would be more aggressive in policing their ranks.
That is the risk that such organizations like UL or National Sanitation Foundation take when they certify an product or company. They must also be ready to decertify if their reputation is have value in the market place.
Arthur Andersen discovered this the hard way.
Skeptic_Heretic
5 / 5 (1) Jun 13, 2010
What contract Marjon? No contracts in a free market because there is no government authority. Again, you don't understand what you're asking for. It is obvious that you're just a Beck parrot.
marjon
1 / 5 (2) Jun 13, 2010
Governments are not required to enforce contracts.
All that is required is that the word is spread throughout the society that you violate contracts, that you lie and cannot be trusted.
You will either have to make efforts for society to trust you or you will not have many customers. If you decide to take by force anything you may need since no one will trust you or trade with you, be prepared to be met with force in return.
Third party enforcement (government or arbiters) of contracts strengthens a contract, but is not required.
There are many free market elements in use today to enforce contracts. One is your credit rating.
marjon
1 / 5 (1) Jun 14, 2010
"Since 2005 the regime (DPRK) has been reasserting its grip on the economy, with controls or outright bans on the private markets. "
The ruling communist party announced in a directive on May 26 that there would be no state rations for a while, said South Korea's Good Friends group which has contacts in the North.

People were authorised to buy food supplies through private markets, it said, adding the directive was due to delayed shipments of food from China."
http://www.spacew...999.html
When governments fail, private markets meet the need.
marjon
1 / 5 (1) Jun 14, 2010
Even the US government has enough wisdom to respect private markets to meet the food needs of its needy.
The government provides vouchers to the needy so they many purchase their own food from a private market instead of waiting for a government bureaucrat to arrange for the food.
Skeptic_Heretic
not rated yet Jun 14, 2010
The government provides vouchers to the needy so they many purchase their own food from a private market instead of waiting for a government bureaucrat to arrange for the food.
If the food is already present, they don't need food delivery, they need money.

Voucher systems replace money, not items, and are used when the items are already in situ. No one can really be this ignorant, you must be trolling.
marjon
3 / 5 (2) Jun 17, 2010
"Governments have intervened too much in free markets since the crisis started, to the point that they are affecting the health of the world economy, Marc Faber, the author of "The Gloom, Boom & Doom Report" told CNBC Thursday."
"Government stimulus packages create volatility in stock markets because they distort economic indicators, said Faber, who predicted that the US will implement another stimulus."
""The central bankers are precisely the ones that don't know that excessive money creation and excessive debt creation leads to a crisis down the road.""
http://www.cnbc.c...37747651

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