CHICAGO, IL – The American Medical Association welcomed President Obama to its annual meeting in Chicago. Like the president, the AMA is committed to health reform this year that provides all Americans with affordable, high-quality health coverage.
“We have a historic opportunity for reform this year, and the AMA is actively working for health reform that covers the uninsured, makes insurance more affordable, increases the value our nation receives from its health-care spending and enhances prevention and wellness for patients,” said AMA President Nancy H. Nielsen, M.D.
In the days following the speech, the Congressional Budget Office released reports challenging whether payment structure of Obama’s proposals. Democrats and Republicans each have versions of bills that will be debated throughout the summer.
But as politics continued in Washington, President Obama addressed the AMA to garner support from, and outline benefits and changes specific to, physicians.
Highlighting physicians’ commitment to their patients, President Obama said to a standing ovation that “you did not enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers – and that’s what our health care system should let you be.”
“The relationship between a patient and physician is the heart of health care, and we support reforms that preserve that relationship and keep medical decisions in the hands of patients and physicians,” said Dr. Nielsen.
President Obama also recognized that it “will be hard to make some of these changes if doctors feel like they are constantly looking over their shoulder for fear of lawsuits.” He also acknowledged the cost of defensive medicine in the health system.
“We are very pleased that President Obama has expressed an openness to medical liability reform as part of comprehensive health reform,” said Dr. Nielsen. “Liability reform is clearly needed to help doctors implement best-practices in patient care and reduce unnecessary health costs.”
President Obama said “I need your help, doctors. To most Americans, you are the health care system.” He also told physicians that “I will listen to you and work with you to pursue reform that works for you.”
Following are highlights of the President’s speech:
On his Reform Proposals:
First, we need to upgrade our medical records by switching from a paper to an electronic system of record keeping. And we have already begun to do this with an investment we made as part of our Recovery Act… As Newt Gingrich has rightly pointed out, we do a better job tracking a FedEx package in this country than we do tracking a patient’s health records. You shouldn’t have to tell every new doctor you see about your medical history, or what prescriptions you’re taking. You should not have to repeat costly tests. All of that information should be stored securely in a private medical record so that your information can be tracked from one doctor to another – even if you change jobs, even if you move, and even if you have to see a number of different specialists.
The second step that we can all agree on is to invest more in preventive care so that we can avoid illness and disease in the first place. That starts with each of us taking more responsibility for our health and the health of our children.
Building a health care system that promotes prevention rather than just managing diseases will require all of us to do our part. It will take doctors telling us what risk factors we should avoid and what preventive measures we should pursue. And it will take employers following the example of places like Safeway that is rewarding workers for taking better care of their health while reducing health care costs in the process.
Our federal government also has to step up its efforts to advance the cause of healthy living. Five of the costliest illnesses and conditions – cancer, cardiovascular disease, diabetes, lung disease, and strokes – can be prevented. And yet only a fraction of every health care dollar goes to prevention or public health.
On Current Problems in the System and How to Fix Them
One Dartmouth study showed that you’re no less likely to die from a heart attack and other ailments in a higher spending area than in a lower spending one.
There are two main reasons for this. The first is a system of incentives where the more tests and services are provided, the more money we pay. And a lot of people in this room know what I’m talking about. It is a model that rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can’t spend much time with each; and gives you every incentive to order that extra MRI or EKG, even if it’s not truly necessary. It is a model that has taken the pursuit of medicine from a profession – a calling – to a business.
You entered this profession to be healers – and that’s what our health care system should let you be.
That starts with reforming the way we compensate our doctors and hospitals. We need to bundle payments so you aren’t paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how you treat the overall disease. We need to create incentives for physicians to team up – because we know that when that happens, it results in a healthier patient. We need to give doctors bonuses for good health outcomes – so that we are not promoting just more treatment, but better care.
And we need to rethink the cost of a medical education, and do more to reward medical students who choose a career as a primary care physicians and who choose to work in underserved areas instead of a more lucrative path. That’s why we are making a substantial investment in the National Health Service Corps that will make medical training more affordable for primary care doctors and nurse practitioners so they aren’t drowning in debt when they enter the workforce.
The second structural reform we need to make is to improve the quality of medical information making its way to doctors and patients. We have the best medical schools, the most sophisticated labs, and the most advanced training of any nation on the globe. Yet we are not doing a very good job harnessing our collective knowledge and experience on behalf of better medicine. Less than one percent of our health care spending goes to examining what treatments are most effective. And even when that information finds its way into journals, it can take up to 17 years to find its way to an exam room or operating table.
As a result, too many doctors and patients are making decisions without the benefit of the latest research.
So, one thing we need to do is figure out what works, and encourage rapid implementation of what works into your practices.
Let me be clear: identifying what works is not about dictating what kind of care should be provided. It’s about providing patients and doctors with the information they need to make the best medical decisions.
On Malpractice and Defensive Medicine
Now, I recognize that it will be hard to make some of these changes if doctors feel like they are constantly looking over their shoulder for fear of lawsuits. Some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That’s a real issue. And while I’m not advocating caps on malpractice awards which I believe can be unfair to people who’ve been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That’s how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.
Insurance for All Americans
So, we need to do a few things to provide affordable health insurance to every single American. The first thing we need to do is protect what’s working in our health care system. Let me repeat – if you like your health care, the only thing reform will mean is your health care will cost less.
If you don’t like your health coverage or don’t have any insurance, you will have a chance to take part in what we’re calling a Health Insurance Exchange. This Exchange will allow you to one-stop shop for a health care plan, compare benefits and prices, and choose a plan that’s best for you and your family – just as federal employees can do, from a postal worker to a Member of Congress.
How to Pay for Reform
Let me explain how we will cover the price tag. First, as part of the budget that was passed a few months ago, we’ve put aside $635 billion over ten years in what we are calling a Health Reserve Fund. Over half of that amount – more than $300 billion – will come from raising revenue by doing things like modestly limiting the tax deductions the wealthiest Americans can take to the same level it was at the end of the Reagan years…
We also have to make spending cuts in part by examining inefficiencies in the Medicare program…First, we should end overpayments to Medicare Advantage. Today, we are paying Medicare Advantage plans much more than we pay for traditional Medicare services. That’s a good deal for insurance companies, but not the American people. That’s why we need to introduce competitive bidding into the Medicare Advantage program, a program under which private insurance companies offer Medicare coverage. That will save $177 billion over the next decade.
Second, we need to use Medicare reimbursements to reduce preventable hospital readmissions. Right now, almost 20 percent of Medicare patients discharged from hospitals are readmitted within a month…By changing how Medicare reimburses hospitals, we can discourage them from acting in a way that boosts profits, but drives up costs for everyone else. That will save us $25 billion over the next decade.
Third, we need to introduce generic biologic drugs into the marketplace. These are drugs used to treat illnesses like anemia. But right now, there is no pathway at the FDA for approving generic versions of these drugs. Creating such a pathway will save us billions of dollars. And we can save another roughly $30 billion by getting a better deal for our poorer seniors while asking our well-off seniors to pay a little more for their drugs.