Obama tells AMA, "I need your help"

President Obama attempts to alleviate physicians' concerns over what shape health system reform will take. AMA leaders welcome the president's willingness to work together.

By Amy Lynn Sorrel — Posted June 15, 2009

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President Barack Obama today delivered his pitch for health care reform in an attempt to win over the nation's physicians.

His remarks at the American Medical Association's House of Delegates policymaking meeting were met with friendly response from the organization's leadership and more than 500 physician-delegates.

In a nearly hour-long speech, Obama spelled out a number of areas of common ground with the medical profession, and did his best to alleviate some of physicians' concerns in discussing his priorities. Above all, he emphasized the urgency of health system reform.

"The status quo is not acceptable," he said. "My signature on a bill is not enough. I need your help. Doctors, to most Americans, you are the health care system. ... That's why I will listen to you and work with you to pursue reform that works for you."

In a detailed speech, Obama reviewed elements he sees as critical to accomplishing his goals, many of which physicians share. At the top of his list were: slowing the spending curve in health care costs; reforming the Medicare payment system so doctors are paid for quality, not quantity; and modernizing health care administration toward electronic medical records.

In addition to changes to the health system, Obama addressed how to ensure coverage for the nation's almost 46 million uninsured. That includes an option for a public insurance plan -- a potential sticking point for some physicians and a topic under discussion at the AMA's Annual Meeting. AMA leadership has been clear that they are not opposed to a public plan, but are resistant to a Medicare-like program that mandates physician participation and pays less than their costs.

But Obama reassured physicians, "No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period."

Physicians are split over whether a public option will crowd out private insurance alternatives. Obama tried to dispel that concern.

"The public option is not your enemy. It is your friend," he said, noting it could help cut waste and ensure accountability in the private market.

Obama's opposition to caps on noneconomic damages in medical liability cases elicited a negative response. Some delegates booed at the mention of his stance in a speech that otherwise was punctuated by applause and standing ovations. Obama acknowledged the ongoing liability pressures facing physicians and promised to explore other alternatives.

The AMA's elected leaders reacted warmly to the speech, especially his openness to some action to address liability insurance costs.

"We were thrilled that this is the first Democratic president who's talked with us about any kind of liability reform," said AMA President Nancy H. Nielsen, MD, PhD. "That's good news."

The White House is reportedly open to providing some kind of liability option to doctors who comply with physician-developed quality standards.

Regarding controversy over a potential public insurance option, Dr. Nielsen said the president struck the right tone in focusing the debate on policy details rather than political rhetoric.

"We are very much encouraging not only our members, but the public, to not look at labels, and not let fear-mongering or rhetoric get in the way of a plan that we haven't even fleshed out yet," she said.

J. James Rohack, MD, a Texas cardiologist who assumes the AMA's presidency Tuesday evening, said Obama's decision to speak to the House of Delegates sent a strong signal.

"The president's coming to the AMA recognizes the central role that physicians play in health care," Dr. Rohack said. "In any discussion of health system reform, if doctors don't believe it's going to be better for patients, we'll let patients know."

Kevin O'Reilly contributed to this story.

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