extremophile

For those of you who didn’t notice the AMA yesterday stated its decision to oppose the public health option that is being discussed as part of health care reform.  This adds to a 70 year history by the AMA of opposing any state involvement in health care.  One can of course understand their objection.  It could lead to a decline in doctors’ salaries.  But it is as if they also believe the propaganda that they have helped promote about “socialiazed” medicine, as in the LP they  distribute as part of their 1961 Operation Coffee Cup Campaign with Reagan talking about how “socialized medicine” was a sure root to communism.  “One of the traditional methods of imposing statism or socialism on a people has been by way of medicine,” Regan said.  And one of the primary examples Reagan provided was the idea that the government could tell doctors where or where not they might practice.  Echoes of this delusional concern can be see in the AMA’s response to the New York Times article indicated above in which the organization states that it is not against the idea of universal health care, but that against any public option that “forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates…” Well, on the one hand the AMA doesn’t want doctors “forced” to participate (but how will a universal system work if all doctors are not required to accept all the insurance options?) and yet they also just don’t want any expansion of a Medicare system or a system that forces doctors to accept “Medicare rates,” that is lower rates.

Well, as I said just above, I can understand all of these concerns — the organization just appears to be defending the interests of its professional members, namely their renumeration and autonomy — but there is another obligation one would expect the AMA to uphold: that is the ethical obligation that extends from the Hippocratic oath, which in a modern context should mean supporting not just the interests of doctors but also a healthy reform of the existing system.  The public hasn’t seen the plan yet about the shape of the public health plan that Obama and others have suggested, but the principle to me at seems to be a good one.  People can keep their exisitng private plans.  Those plans will be restructured leading to lower rates because the entire business model of the private insurers will be modified by the fact that they will be required to accept all applicants regardless of preexisitng conditions.  The idea, as I understand it, is that the insurers are willing to participate because they will make up the difference by wider participation.  The reasons that insurers and now the AMA don’t like the private plan is that they think that the govenrment plan will price fix (that’s why the AMA doesn’t want docotrs to be “forced” to particpate in a public plan) and that the private insurers won’t be able to compete and will go out of business.

But I don’t think this is what will happen.  I think a public health insurance option will just be another factor keeping the private insurers on their toes.  The way I see it, there is not reason that the government should not also be allowed to compete.  Short of making health care — like policing and fire fighting — a purely governnment obligation, I don’t see why we shouldn’t tolerate a mixed private-government system.  We have seen successful examples of this already.

One example, is the student loan program created by Clinton which enabled the govenrment to loan “Federal Direct” loans to students at lower rates, and which competed with the alternate system (establihsed under Reagan I think) in which the government essentially paid private insurers to provide cheap loans to students.  Well, the Federal Direct loans are cheaper because the government can provide cheaper laons and moreover the government organization runs pretty efficiently.  In fact, a few years ago a scandal emerged in which private loan organizations were bribing and in some cases threatening loan officers at colleges so that they would not provide federal loans.  And at the same time, it turns out they were lobbying congress to say that the federal government should not be allowed to innovate, that it was unfair.

I see a similar idea emerging among those like the AMA and other who oppose the public option.  They don’t want the government to be able to compete and to innovate in the field of health care.  Because the fact is that they know that, even without price fixing, they are worried that the govenrment might just put up a pretty efficient and effective plan.  But why should the government not be allowed to compete?  Isn’t the whole point that our healthcare has become too expensive?  If the govenrment is in a position to compete with private insurers for who can provide the most efficient and cheap healthcare, should the government be allowed to compete?  This is not top-down socialism.  This is the government competing in the market with the consumers positioned as the ultimate judge.  This fits well within the logic of our existing decidedely consumer driven logic.  By contrast, it is really the AMA and the private insurance lobby that appear to be effecting a top down model of governnance in which they ensure that consumers will never get the public option.  In any case, I just called the AMA to give them a peace of my mind and to remind them of the obligations that I believe extend from the Hippocratic oath in this modern and contemporary context.  Here is the number if you too have the urge to let them know what you think about their opposition to the public option: (202) 789-7447.