Government
AMA letter backs Obama's broad principles for health system reform
■ The Association outlines the next steps Congress and the White House should take to turn the tenets into policy changes.
By Chris Silva — Posted April 27, 2009
- WITH THIS STORY:
- » Obama's 8 principles
- » DeParle weighs in on health system reform
- » Related content
The American Medical Association earlier this month further fleshed out what it will push for in this year's landmark health system reform debate, aligning itself with several core principles from President Obama and offering more specifics about how to achieve them.
In an April 13 letter to the White House, the AMA announced its strong support for eight guiding principles against which Obama has said he will gauge the health reform effort as he works with Congress. The AMA made the statement in an effort to show it is backing this "historic opportunity to improve the system," while also highlighting more specific issues the organization wants Congress to address this year, said AMA President Nancy H. Nielsen, MD, PhD. She co-signed the letter with AMA President-elect J. James Rohack, MD.
"We are committed to reform, and we want to expand access to care for all Americans," Dr. Nielsen said. "This is an important year, because more people may lose their jobs and their health insurance, and we have grave concerns about that and the loss of preventive services."
The eight basic principles -- including guaranteeing patient choice and aiming for universal health care coverage -- lack details, although Obama further outlined his long-term vision in his budget proposal released Feb. 26. The AMA letter indicates that the standards dovetail with more expansive policy changes for which the Association already is pushing.
But embracing the eight principles does not mean the AMA necessarily backs every idea on health reform that Obama has revealed so far. For instance, the president has called for creating a public health plan option linked with a national health insurance exchange to serve as competition for private plans. In its letter to the White House, the AMA says it supports a health insurance exchange to ensure coverage choice and portability, but it does not weigh in on the public plan option. To move toward universal coverage, Congress should build on the employer-based system and strengthen the safety net provided by publicly financed programs such as Medicare, Medicaid and the Children's Health Insurance Program, Dr. Nielsen and Dr. Rohack wrote.
Dr. Nielsen stressed that the organization is mindful of the need to watch the dollar signs as policymakers work toward the goal of universal coverage. "It's very important for us that all Americans have health care coverage that's affordable. But we do understand that we can't afford everything for everybody, so we need to have fiscally responsible conversations."
The letter proposes expanding on Obama's principles in a number of ways, including:
- Reforming and improving the insurance market through the use of modified community rating, guaranteed renewability and fewer benefit mandates.
- Assisting low-income individuals through premium subsidies and cost-sharing assistance.
- Promoting medical home models to reduce system fragmentation and improve care coordination.
- Establishing antitrust reforms that would allow groups of physicians to contract jointly with payers as long as the doctors certify they are collaborating on health information technology and quality improvement initiatives.
- Easing the effect of liability pressure on the practice of defensive medicine through innovative approaches, such as health courts, early disclosure and compensation programs, and expert witness qualification standards.
Some signs of progress
Dr. Nielsen said she is encouraged by the progress already made in talks about Medicare physician payment reform, a key part of the AMA's broader health system reform agenda. Physicians soon may begin to see pilot programs testing various payment models in an attempt to find long-term alternatives to the current system, she said. "It's early, but there's no question that's on the table."
In his fiscal 2010 budget proposal, Obama said Medicare's physician pay cuts as mandated by law are not practical. He said Congress should plan on spending $330 billion over the next decade to repeal the current pay system instead of simply patching it year after year.
The next steps on the issue are up to lawmakers. The AMA was one of more than 70 medical organizations that signed an April 13 letter to the House Budget Committee asking Congress to retain a section in the House budget proposal that could make it easier for lawmakers to approve a payment overhaul. By suspending "pay as you go" rules for a large initial portion of a physician pay proposal, the House budget would obviate the need to find hundreds of billions of dollars in offsets otherwise needed to prevent the overhaul from running up deficit spending. At this article's deadline, lawmakers were still negotiating over the differences between the House budget blueprint and the Senate version, which does not include the pay-go exemption.
At least two key Senate leaders think Congress can move quickly, even though it is contemplating the largest health system overhaul proposed in 15 years. "We have jointly laid out an aggressive schedule to accomplish our goal" of enacting comprehensive health system reform, said an April 20 letter to Obama from Senate Finance Committee Chair Max Baucus (D, Mont.) and Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D, Mass.). Both committees plan to mark up legislation in early June.