AMERICAN MEDICAL ASSOCIATION

AMERICAN

MEDICAL

ASSOCIATION

The AMA’s position on current health care reform proposals

Brief History• The American Medical Association is comprised of

approximately 250,000 physicians and medical students. With this many members, it is America’s largest physician organization. It was founded in 1847 by Dr. Nathan Smith Davis.

•The AMA was originally founded to elevate the standard of medical education in the US, to advance the science of medicine, to develop a program of medical ethics, and to improve the health of the public. The AMA works to advocate for the physician, the patient, and the profession.

Stakeholders

• The stakeholders involved in this discussion today are the physicians who practice in the United States as well as the patients for whom they are providing care.

Main Concerns of Stakeholders• AMA is opposed to government-sponsored insurance plans

which have been proposed by President Obama and many other Democrats.

• The AMA is committed to the goal of affordable health insurance for all but believe that it should be provided through private markets as they are currently.

• The AMA does not believe that creating a public health insurance option for the non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs.

• The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70% of Americans.

Main Concerns of Stakeholders

• The AMA does not endorse any plan design that mandates physician participation. Many physicians and providers may not have the capability to accept the influx of new patients that could result from such a mandate.

• Does not agree with the proposed Medicare physician payment reform. This would cut physician payment by 21% for Medicare and Tricare patients and threatens the availability of primary care to seniors and active military personnel and their families.

Some of organizations goals for healthcare reform include:

• Extending coverage to the uninsured. • Prohibiting insurance companies from denying

coverage based on pre-existing conditions or establishing annual or lifetime caps on benefits.

• Promoting preventative healthcare and wellness services.

Endorsements

• Senate bill- AMA currently endorses it despite remaining opposed to a number of provisions and will consider withdrawing endorsement if the Sustainable Growth Rate Formula is amended.

• House bill-AMA currently endorses. It is not a perfect representation of the views of the AMA but is close enough to warrant the group’s support and keep the health care reform process moving forward. Again, the bill needs to be accompanied by legislation reversing scheduled Medicare reimbursement payment reductions to physicians.

Informative Web Sites

• dpc.senate.gov

• energycommerce.house.gov

Social, Legal, and Economic Issues related to the issue

Social• There are seven different points on the Health care reform

that the AMA support:– Health insurance coverage for all Americans– Insurance market reforms that expand choice of affordable

coverage and eliminate denials for pre-existing conditions– Assurance that health care decisions will remain in the hands of

the patients and their physicians not the insurance companies or government

– Investments and incentives for quality improvement and prevention and wellness initiatives

– Repeal of the Medicare physician payment formula that triggers steep cuts and threaten seniors access to care

Social, cont’d.– Implementation of medical liability reforms to reduce the cost of

defensive medicine– Streamline and standardize insurance claims processing.

• This could mean more funding to be able to research what best works for their patients. In turn that would benefit them economically because they get more money for research and with that research comes the ability to have a name on new discovery.

• It will help protect the relationships between their patients and their physicians.

• It provides affordable health insurance for all.• AMA affirmed support in the health system reform alternatives that

are consistent with the policies, freedom of choice, freedom of physician practice and universal access for patients.

Social, Legal, and Economic Issues related to the issue

Legal• It will change the way they report their Medicare and Medicaid

payments and services.

Economic• The AMA agrees with the house regarding Medicaid payment levels

and rates, which would improve access to care for people. Lobbyists are in place to help physicians against the potential new causes that could affect the payment adjustments that they will get with services they provide.

• It means that more of the patients with insurance that physicians see the more likely they will get paid for the services that they provided, than with a patient that does not have any insurance. In the end it could mean lower insurance premiums for all.

Ethical Principles

• Ethical principles of the AMA related to healthcare reform focus around access to healthcare.

• Much has been written by AMA members on this topic but one essay published in Hastings Center Report addresses ethical concerns when looking at healthcare reform proposals.

• CEJA or Council on Ethical and Judicial Affairs has addressed this issue and has written a report for the AMA with recommendations.

Ethical Principles

• Essay: Improving Healthcare Access: A consensus ethical framework to guide proposals for reform– Framework derived from Ethical Force Program’s

standardized process. (Institute for Ethics, AMA)– Proposes ethical obligations and

recommendations.– Proposes expectations for fairness of coverage.

Essay: Improving Healthcare Access: A consensus ethical framework to guide

proposals for reform1. Every member society should have adequate

array of core healthcare benefits. – Recommendation: reform should address cost,

quality, and access.

2. Contents and limits of healthcare benefits establish through ethical process.– Recommendation: reform adhere to detailed ethical

framework to ensure fair coverage decision.

Essay: Improving Healthcare Access: A consensus ethical framework to guide

proposals for reform

3. Healthcare system must be sustainable. – Recommendation: reform have set goals for allocation of

shared resources, shared resources for all defined so as to establish core benefits package, revisable and responsive to change, and universality should not be sacrificed for sustainability.

4. Clear responsibility for stakeholders to be accountable. – Recommendation: individual and societal, encourage to

use resources efficiently, monitor to reduce waste and fraud, and partners in healthcare with mutual respect.

Essay: Improving Healthcare Access: A consensus ethical framework to guide

proposals for reform1. Transparency: process for designing and administering

healthcare transparent to those affected.2. Participatory: organizations should involve all

stakeholders in process.3. Equitable and Consistant: process result in similar

decisions under similar circumstances.4. Sensitive to Value: process consider net health outcomes

of services and resources required.5. Compassionate: respond to individuals values and needs,

attentive to most vulnerable with critical needs.

Ethical Principles

• Council on Ethical and Judicial Affairs (Report 2-A-09) – June 2009

• Response to resolution 704 presented by Colorado Delegation.

• AMA’s “Principles of Medical Ethics” (Principle 9)

• Impact of financial barriers and obligations of healthcare.

• Recommendations to AMA.

Stakeholder Association

• The most important mutual interest that all of the associations want from the health care reform is that there is health care insurance for all Americans.

• The insurance for all Americans need to be affordable and accessible.

• Health information technology is a mutual interest in Pharmacists, Hospitals, AMA and Insurance Companies.

Stakeholder Association

• ANA and AMA agree that the health care reform should be patient-centered which means that the health care decisions are in the hands of the physician and the patient not the government and the insurance companies.

• AMA and the insurance companies what want to standardize the claim process to make it simpler.

Conclusion

References