Obama Lobbies AMA On Changes To Health Care

President Obama's plans for overhauling health care got a checkup from the nation's doctors on Monday. Members of the American Medical Association cheered Obama when he called for a system that would allow them to spend more time treating patients and less time processing insurance forms.

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Good morning. President Obama knew he faced a roomful of skeptics yesterday. He was speaking to the American Medical Association. That doctors group has opposed past efforts to reform health care, the same goal the president has set for himself. At one point doctors actually booed when the president talked about medical malpractice suits, but doctors cheered yesterday when President Obama suggested changes to let them spend more time with patients and less with paperwork. NPR's Scott Horsley reports.

SCOTT HORSLEY: As he campaigns for health care reform, president Obama has been collecting stories about the shortcomings of the current system - families who can't pay their bills, companies that can't afford to cover their workers, and governments that are going broke because of soaring health care costs. Yesterday, as he spoke to a meeting of the American Medical Association in Chicago, Mr. Obama added another category of victim - doctors who are so busy pushing papers they hardly have time to treat their patients.

Doctors applauded the president when he called for a health care system that would let them function as healers rather than bean counters, and Mr. Obama knows when it comes to pushing a new health care system, the applause of doctors means a lot.

President BARACK OBAMA: We listen to you, we trust you. That's why I will listen to you and work with you to pursue reform that works for you.

(Soundbite of applause)

HORSLEY: In some cases though, controlling health care costs may require physicians to heal themselves. Mr. Obama said one of the main reasons America's health care tab is so high is that too many doctors are performing unnecessary tests and procedures because of the way they're paid.

Pres. OBAMA: And a lot of people in this room know what I'm talking about. It's 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 necessary.

HORSLEY: Some doctors argue they perform more tests and procedures in response to the threat of malpractice suits, and Mr. Obama acknowledged some protection maybe necessary.

Pres. OBAMA: I want to work with the AMA so we can scale back the excessive defensive medicine that reinforces our current system, and shift to a system where we are providing better care, simply - rather than simply more treatment.

HORSLEY: The president said he's opposed to an outright cap on malpractice awards, a favorite prescription for many doctors. But AMA president Nancy Nielsen was still pleased.

Dr. NANCY NIELSEN (American Medical Association): What we were thrilled about is that this is the first Democratic president that's talked with us about any kind of liability reform. So that was the good news.

HORSLEY: AMA leaders stressed their agreement with the president on the need to provide health insurance to all Americans, although the association is still worried about Mr. Obama's call for a public insurance plan. The president says a public option is needed to keep private insurance companies honest.

Pres. OBAMA: What I refuse to do is simply create a system where insurance companies suddenly have a whole bunch of more customers on Uncle Sam's dime but still fail to meet their responsibilities.

(Soundbite of applause)

HORSLEY: The AMA is primarily worried that a public plan would function like Medicare, compelling doctors to accept below-market rates for the care they provide. White House spokesman Robert Gibbs told reporters on Air Force One a public option could be structured in many different ways.

Mr. ROBERT GIBBS (White House Press Secretary): There are a lot of different ways to get to all these points. That's why you heard the president say in the campaign, talk about having a big table with lots of chairs. I think this is another stop on the big table tour.

HORSLEY: Mr. Obama's challenge, as he woos doctors, hospitals, drug companies and consumers, is keeping everyone at the table long enough to make a deal.

Scott Horsley, NPR News, Washington.

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What Happened To The AMA's Clout?

The American Medical Association likes to call itself the voice of medicine. But lately it seems to be getting laryngitis.

Long one of the lobbying titans in the halls of Congress, the AMA is now just another voice in the cacophony of medical interest groups. And while it's still the largest physician group, the AMA represents an increasingly smaller percentage of the nation's practicing physicians — about one-third, by most counts.

Yet President Obama still considered the group important enough to pay a house call to its annual House of Delegates meeting in Chicago, in recognition of the fact that while the AMA may not be able to dictate the terms of what type of health overhaul can pass Congress, it could still help gum up the process.

The AMA "may not be what it once was," says Rep. Michael Burgess (R-TX), a physician and former member of the AMA's policymaking body. But at the same time, Burgess says, "anytime you talk to a member [of Congress] about something in regards to health care, they will ultimately ask you, 'Well, where's the AMA on this?' So they do have considerable clout."

Historically, the AMA has been largely white, male and Republican. But the rest of the medical profession is more diverse, and doctors differ on what they want to see in a changed health care system.

"Medicine isn't monolithic anymore," says health care consultant Robert Laszewski. "About the only thing every physician in America can agree on is, 'Don't cut my pay.' "

In fact, one of the key issues in a health care overhaul is threatening to touch off a civil war within the medical profession, Laszewski says. It's the fact that there's widespread agreement that primary care doctors — for example, those who practice family medicine and pediatrics — are today underpaid and need to be paid more.

"But the only way primary care physicians get more money is if certain specialties get less money," he says. "So it really gets down to a contest between the various specialty groups as to who gives up and who doesn't."

But while doctors may end up bickering among themselves, those who want to get a health care overhaul passed want to make sure that doctors don't become opponents. The AMA is legendary for having helped defeat efforts to create national health insurance in the 1930s and 1950s, and almost prevented the passage of Medicare.

Even in its weaker state, says Laszewski, "if the physician community stands up and says, 'This would be bad for you,' a lot of consumers are going to believe and accept that."

That makes keeping doctors happy and on board a key goal of President Obama and his allies.

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