What Would George Say?

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Commentary — November 2013

By Robert M. Tenery, MD

When the American Medical Association first threw its support behind the Obamacare legislation, I did not agree but accepted the decision because I believed in the adage that "the House of Delegates of the AMA knows best." Put simply, consensus decisions are usually more likely to be of benefit to the whole than decisions by a single individual. After receiving a copy of the July 1, 2013, issue of American Medical News (AMNews), I now question that adage.

Although some would take issue with me, AMNews was the mouthpiece of the AMA leadership. It did an excellent job of covering issues that affect the medical profession, but it did so under the watchful eye of the AMA Board of Trustees. 

As with virtually all journalism, there was a bias, which is often as much with what is not reported as with what is. For example, under the dictates of the Affordable Care Act (ACA), this country's health care delivery system is going through the most radical transformation since the implementation of Medicare in the 1960s, and the two headlines on the first page of the July 1 AMNews read, "What's Next Now That the AMA Has Declared Obesity a Disease" and "How Med Schools Will Spend Innovation Grants." 

Searching deeper into the periodical, the only reference to the effects of ACA were buried in an editorial by the new AMA Board of Trustees chair when he wrote, "As health reform moves our system to try out new payment and delivery models, it forces us to face questions of ethics and professionalism with respect to how we treat our patients and how we conduct ourselves."

That was it? 

Three days of meetings at the annual session by physician representatives from all parts of the country and virtually every specialty, and the only mention of ACA is the advice from the new board chair on facing the questions of ethics and professionalism in this new system.

What about AMA's position on the employer mandate requirement that could affect every physician aligned with a hospital or a group that has 50 or more employees? What about the punitive damages assessed by the thousands of IRS agents that will be hired to enforce the individual mandate clause of ACA? What about diverting $716 billion in projected funding from the Medicare program over the next 10 years to fund the previously uninsured under the provisions of ACA? What about physicians' loss of autonomy and being shoved further down the revenue stream as hospitals gain even more control in the proposed accountable care organizational model?

These divisive issues have been debated at past meetings and were probably raised again at this meeting. Evidently, they didn't change AMA's policy on ACA. Thus, these widely held concerns by a large contingent in the physician community were not reported.

Newly installed AMA President Ardis Hoven MD, when interviewed by Sarah Kliff on C-SPAN's "Newsmakers" on July 7, seems to put the current AMA position clearly. She said AMA "will do whatever we can in our power to promote Obamacare."

I'm afraid that she will!

Thinking back to an AMA meeting I attended in the 1990s, an attorney from the Department of Justice/Office of Inspector General was granted the privilege of addressing the House of Delegates. The attorney's accusatory presentation implied that a large number of doctors were committing rampant fraud and abuse in billing and overutilization. The stunned attendees and elected delegates sat in silence. After the representative from the nation's capital stepped away from the podium, George Alexander, MD, the chair of our Texas delegation, raised his hand as he approached one of the microphones that dotted the audience.

"Did you hear what he said?" George asked the audience, wringing his hands. He gazed out across those of us in attendance. Then asked again, this time even more forcefully: "Did you hear what he just accused us of?"

Over the next five minutes, he convinced the delegates that physicians didn't have to accept everything the powers in Washington try to "ram down our throats." Dr. Alexander retreated to his chair, but only after receiving a standing ovation. 

If he were still with us, it might be time to get "our George" back — Alexander, that is!

Dr. Tenery is an ophthalmologist in Dallas and a former president of TMA.  


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