June 25, 2009
OP-ED COLUMNIST
The Prescription From Obama’s Own Doctor

From the NYT

By NICHOLAS D. KRISTOF
As a society, we trust doctors to be more concerned with the pulse of
their patients than the pulse of commerce. Yet the American Medical
Association is using that trust to try to block a robust public
insurance option as part of health reform.

In fact the A.M.A. now represents only 19 percent of practicing
physicians (that’s my calculation, which the A.M.A. neither confirms
nor contests). Its membership has declined in part because of its
embarrassing historical record:

- the A.M.A. supported segregation,

- opposed President Harry Truman’s plans for national health insurance,

- backed tobacco,

- denounced Medicare

- and opposed President Bill Clinton’s health reform plan.

So I hope President Obama tunes out the A.M.A. and reaches out instead
to somebody to whom he’s turned often for medical advice. That’s Dr.
David Scheiner, a Chicago internist who was Mr. Obama’s doctor for
more than two decades, until he moved into the White House this year.

“They’ve always been on the wrong side of things,” Dr. Scheiner told
me, speaking of the A.M.A. “They may be protecting their interests,
but they’re not protecting the interests of the American public.

“In the past, physicians have risked their lives to take care of
patients. The patient’s health was the bottom line, not the checkbook.
Today, it’s just immoral what’s going on. It’s abominable, all these
people without health care.”

Dr. Scheiner, 70, favors the public insurance option and would love to
go further and see Medicare for all. He greatly admires Mr. Obama but
worries that his health reforms won’t go far enough.

Dr. J. James Rohack, the president of the A.M.A., insisted to me that
his group is committed to making health insurance accessible for all
Americans, and that its paramount concern is patient health.

“When you don’t have health insurance, you live sicker and you die
younger,” he said. “And that’s not something we’re proud of as
Americans.”

He added that the A.M.A. is not necessarily opposed to a public
option, and I have the impression that it might accept a pallid one
built on co-ops. Dr. Rohack wouldn’t repudiate his association’s
letter to the Senate Finance Committee warning against a new public
plan. That letter declared: “The introduction of a new public plan
threatens to restrict patient choice by driving out private insurers.”

I don’t mind the A.M.A. lobbying on behalf of doctors in the many
areas where physicians and patients have common interests. The
association is dead right, for example, in calling for curbs on
lawsuits, which raise medical costs for everyone.

An excellent study published in 2006 in The New England Journal of
Medicine found that for every dollar paid in compensation as a result
of lawsuits against doctors, 54 cents goes to legal and administrative
costs.

That’s an absurd waste of money. Moreover, aggressive law leads to
defensive medicine, in the form of extra medical tests that waste
everybody’s money. Tort reform should be a part of health reform.

Yet when the A.M.A. uses its lobbying muscle to oppose major health
reform — yet again! — that feels like a betrayal. Doctors work hard to
keep us healthy when we’re in their offices, and that’s why they win
our trust and admiration — yet the A.M.A.’s lobbying has sometimes
undermined the health of the very patients whom the doctors have sworn
to uphold.

I might expect the American Association of Used Car Dealers to focus
exclusively on wallet-fattening, but we expect better of physicians.

In fairness, most physicians expect better as well, which is why the
A.M.A. is on the decline.

“It’s what has led to the decline of the A.M.A. over the last half
century,” said Dr. David Himmelstein, a Massachusetts physician who
also teaches at Harvard Medical School. “At this point only one in
five practicing doctors are in the A.M.A., and even among its members
about half disagree with its policies.” To back that last point, Dr.
Himmelstein pointed to surveys showing a surprising number of A.M.A.
members who support a single-payer system.

For his part, Dr. Himmelstein co-founded Physicians for a National
Health Program, which now has more than 16,000 members. The far larger
American College of Physicians, which is composed of internists and is
the second-largest organization of doctors, is also open to a single-
payer system and a public insurance option. It also quite rightly
calls for emphasizing primary care.

The American Medical Student Association has issued a sharp statement
disagreeing with the A.M.A.

The student association declared that it "not only supports but
insists upon a public health insurance option."

Look, a public option is no panacea, and it won’t automatically set
right the many shortcomings in our health system. But if that option
is killed in gestation, then we’re back to Square 1 and there’s little
hope of progress in solving the vast challenges confronting us.

So, President Obama, don’t listen to the A.M.A. on this issue.
Instead, for starters, call your doctor!