A decade ago, I publicly relinquished my membership in the American Medical Association when it came out in support of the Affordable Care Act. I felt my colleagues were blindly favoring an insurance expansion that would jeopardize quality of care and add to a physician’s growing bureaucratic burden, while not guaranteeing access to actual health care amid prohibitive deductibles and narrow care network. I was right.
Don’t get me wrong, there are many things about Obamacare that I now like, including the Medicaid expansion, the funding and expansion of federally qualified health centers in undeserved areas, and a team approach to health care delivery (Accountable Care Organizations). In fact, these parts of the law have worked out better than I anticipated.
But back then, I still didn’t see how the AMA could back a law that compelled patients to purchase a product that often didn’t deliver what it promised, or provide doctors with the tools to deliver on this promise. Keep in mind that at the same time insurance coverage was expanded, we doctors were also hit with the excessive documentation demands of electronic record keeping.
Obamacare individual mandate is gone
Today, I am proud of my brethren at the AMA and I am rejoining 200,000 other doctors as a member.
Why? For one thing, the individual mandate requiring people to buy coverage is now effectively gone, so I no longer have to blame the AMA and others for it. Instead, I can be more forward thinking, focused on improving rather than replacing the law. But even more important, I am now backing the AMA again because their policymaking House of Delegates has rejected the idea of a single-payer system like “Medicare for All,” as Sen. Bernie Sanders, I-Vt., and others call their version. This is an important vote of nonsupport by the AMA.
Medicare for All would be devastating for doctors, patients and hospitals, not just because we doctors would be paid less to do more but also because our hospitals would suffer from decreased income. Hospitals rely on private insurance to fund everything from procedures to research, and they typically lose money on government-funded insurance.
Medicare for All would be a wrecking ball to the employer-based health care system, which provides coverage for over 170 million people, and is frequently an incentive for taking and keeping a certain job.
Impractical and unworkable: Medicare for All is Bernie Sanders’ political pipe dream
The AMA is right to be allied with other industry groups, including the American Hospital Association, the Blue Cross Blue Shield Association and America’s Health Insurance Plans, in a Partnership for America’s Health Care Future that is spending millions of dollars to fight Medicare for All. The AMA’s rejection of Medicare for All couldn’t be coming at a better time. Hearings for various versions of the plan continue in the House, including a “Pathways to Universal Health Coverage” hearing last Wednesday in the influential House Ways and Means Committee.
Single-payer would infringe on doctor rights
But Medicare for All would not only dry up the money stream, be a job killer for the economy and cost more than $30 trillion over a decade in transition expenses. It would also be a direct threat to the quality of care we can deliver to our patients. Most of us still care about what we do. If a new form of personalized immunotherapy or genetic therapy comes along that my patient needs, I want to be able to use it. How frustrating for both my patient and me if she has to wait weeks or months for a hip replacement, MRI or simply to see a specialist, as in Canada.
We are already heading toward fractured, dissociated health care where waits are getting longer and doctor-patient contact time is being replaced by automated results. Medicare for All, while promising to put everything under one roof, would actually aggravate the problem by making it harder for patients to receive needed treatments.
No country has anything like this: Democrats’ promise of Medicare for All is remarkably misguided and unrealistic
We need the AMA to protect the rights of its individual doctors. Many of us want to be able to continue to practice not just the science but the art of medicine as well. For instance, I have a 90-year-old patient who can’t sleep for worry she would die every night since she received her pacemaker. She needs my reassurance much more than she needs a new sleeping pill. I also have a 78-year-old patient with seven medical problems, including high cholesterol, high blood pressure, a creaky knee and sudden chest pain. She needs me to be her quarterback — not to simply spit out test results and referrals.
It’s not that Medicare for All would prevent me from injecting my heart and soul into my practice. But it would certainly make it more difficult by not acknowledging the importance of the time-heavy nuances that my patients and I treasure the most.
This time, the AMA is standing up for improving what’s already working, rather than undermining it with more government overreach.
Marc Siegel, a member of USA TODAY’s Board of Contributors and a Fox News medical correspondent, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. Follow him on Twitter: @DrMarcSiegel