AMA Reaffirms Support For Health Law Component

Robert Siegel talks with Dr. Cecil Wilson, outgoing president of the American Medical Association. At its annual meeting in Chicago, the group reaffirmed its support on Monday of a key requirement of the federal health care law: the mandate that nearly all Americans buy health insurance. Some AMA members had argued the association should drop its support of the controversial measure.

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ROBERT SIEGEL, host:

There was a vote yesterday on the individual mandate, the provision of the Patient Protection and Affordable Care Act, the Democratic health care plan that says people have to buy health insurance or pay a penalty. The vote was 326 in favor of still supporting the individual mandate and 165 opposed.

It was not a legislature that took that vote. It was the House of Delegates of the American Medical Association, which reaffirmed the position it took in favor of mandating coverage back in 2006.

Joining us to talk about that and also about other issues the doctors are concerned about is Dr. Cecil Wilson, who is the outgoing president of the AMA, and who's in Chicago.

Welcome to the program once again.

Dr. CECIL WILSON (President, American Medical Association): Well, thank you so much.

SIEGEL: First, which is the more appropriate message to read in that vote: that AMA delegates support the individual mandate two to one, or that as many as a third are opposed and you had to have a vote in the first place?

Dr. WILSON: Well, I think the message is that two-thirds of the delegates in the house reaffirmed AMA policy, which was put in place back in 2006 before health system reform was even on many people's radar screens. And I think it's important to note that during the intervening five years, there are still no evidence that we can achieve the kind of coverage that we think is important for the American people without people who can pay for it, assuming that responsibility...

SIEGEL: Without everyone anteing up to...

Dr. WILSON: Absolutely.

SIEGEL: You know how contentious this is, and there are legal challenges to the mandate. Will the AMA file a Friend of the Court Brief in support of the individual mandate?

Dr. WILSON: The AMA will not file a Friend of the Court Brief. We do not see that as our role. We see our role as influencing legislation and as establishing this policy. We believe that there are others certainly in the federal government who will be defending that law, and we will follow that very closely.

SIEGEL: Let me bring you to another issue of concern for the doctors and the Congress. Every year, doctors and the Congress have been going through the same routine over Medicare reimbursement rates. And since the cuts that are actually called for by law in those rates have usually been averted by Congress, the amount that doctors are scheduled to be cut by each year rises each year to the point where you now, in theory, face a 29 percent cut in Medicare reimbursements.

Inevitably, doctors end up being spared that cut are getting some small increase. If you threw out that whole system, how could the country decide how to compensate doctors for treating Medicare patients without overpaying them or without underpaying them?

Dr. WILSON: Yeah. The problem with that system is the way it was set up has just not worked. And it has put physicians in the position of being threatened every year. And each time those cuts were delayed the potential for cuts went even higher.

SIEGEL: Yes. They mount with each year. But except for 2002, they've never actually been implemented in any recent years. So...

Dr. WILSON: But the lack of an adequate increase so to cover the cost of providing care means at this point, physicians are paid some 19 percent lower than they would have been if the payments had responded to just the rise in inflation.

And to your other point, and that is what is the alternative, the AMA has suggested an approach. And that is, one, is to get rid of this formula. The second is to put in place five years of stable payments that have an increase to reflect the cost of providing care, and during that five years to study alternative delivery and payment models to encourage efficiency at the same time preserving quality.

SIEGEL: But relative to what Americans make typically, doctors are extremely well-paid in our country. And is that part of the equation that's going to have to be altered in coming years if the whole health care economy is returned to something we can afford?

Dr. WILSON: Well, first of all, doctors are valued in this country, and we are most appreciative of that. What we're talking about, though, is access for the patients. And so if part of that physician's practice, which is Medicare, is not paid enough to be able to make that work - that is to pay salaries, to buy equipment, to turn the lights on - then it's going to be patients who suffer for that.

And there's not a way to solve our problems of cost for Medicare by cutting payments to physicians. What that will do is actually decrease access to care because physicians will have to change the mix of patients that they see.

SIEGEL: Well, Dr. Wilson, thank you very much for talking to us. You talk to us shortly after you became president of the AMA, and now, just as you're leaving office at the AMA. So thanks a lot once again.

Dr. WILSON: Well, thank you. And it's my pleasure.

SIEGEL: That's Dr. Cecil Wilson who is the outgoing president of the American Medical Association.

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