I was talking with a military physician colleague of mine the other day when he made a brilliant observation: “we may be working in a necessarily government model here in the Navy, but most of the innovations and technologies we benefit from originated in the private sector.” He added, “furthermore, people think the military or Kaiser model of care proves that non-physicians can work alongside doctors as professional equals in terms of quality and competence, but this is a complete misperception of what actually goes on: we carefully delegate only the easier, healthier, less acute patients to physician extenders—this is the only way that we avoid disasters in the clinical setting.” My friend was talking about the looming dangers that lie ahead in the wake of the new health care reform law. To fully understand how the ‘Affordable Care Act’ got passed in the first place, we must first examine how the Obama administration pulled off one of the most devious deceptions in modern political history.
President Obama’s health care reform plan strategy was simple: reduce the highest education and training-intensive profession in society to that of a hired hand. It accomplished this task by paying off a few well-placed ‘medical leaders’ to betray their own. This behavior was not only reprehensible, but egregiously dangerous for the future of medical care in America.
To make the ‘Affordable Care Act’ seem like it could work, the President needed an ally on the inside—a group that would not only tow the political line, but could also be kept on a short lease. The AMA, which reaped $72 million in federally-sanctioned medical billing copyright revenues in 2010 alone, was dependent upon the government for its fat coffers; they were the logical choice to be the President’s lackey.
The AMA’s total assets for 2010 were listed at $530 million—money acquired with the assistance of Uncle Sam; the AMA did not want to lose their position of comfort and wealth and so they played along despite a true membership of only 15% of practicing doctors in the country. And, thus, the new health care law was endorsed—and promoted—by AMA-affiliated doctors working at the local, state, and national level who succumbed to the allure of greed and power. Instead of simply pursuing the best interests of their physician colleagues and constituents, the American Medical Association and many local and state medical societies fought to preserve their “delegate” status, their positions of influence, and their misguided sense of self-importance.
The AMA’s membership numbers continue to slide year after year (they lost 12,000 members in the 2010 year alone), and yet they posture in print and television ads as if they command a loyal majority.
Let’s look at the AMA’s income source more closely. The AMA has an exclusive contract with the federal government to own, distribute, and charge for the coding books that all medical specialties must use to bill for insurance cases, both government and private. This exclusive deal for the CPT (current procedural terminology) codes nets the AMA between $70 million and $100 million annually via compact disc and book sales (the AMA’s CPT revenue for 2010 was $72 million). Coupled with the sales of disability and life insurance policies, the AMA makes a true profit each year of several hundred million dollars—money it has not spent wisely. Notwithstanding its recent, dubious outrage at the government for instituting more onerous European-style diagnosis codes (called the ICD-10), the AMA is sitting pretty and ready to do the bidding of its federal master.
Dissecting the AMA’s abuse of power and influence further, it looks like the AMA has the copyright on the Center for Medical and Medicaid Services form (CMS-1500 form), previously known as the AMA-1500. The AMA is the leading member of a company called NUCC that oversees the content and implementation of uniform coding for all health care transactions. In other words, the AMA gets a cut every time a physician submits a claim for payment using the CMS-1500. It is one thing to accept the AMA’s ownership of the copyright to a coding system, but quite another to learn that the AMA owns the copyright to the very piece of ‘paper’ (or computer screen) that everyone must use to submit a medical claim to get paid by Medicare. Every other federal form in the United States is free, but not the AMA form. People don’t have to buy an IRS tax forms, but doctors must literally pay the AMA gatekeeper to simply gain access to the system which allows reimbursement for services they have already provided to patients. This smacks of third-world cronyism, and seems awfully un-American.
The website and bylaws of the private company run by AMA, which manages the CMS-1500 form content and protects its revenue, is as follows: http://www.nucc.org/images/stories/PDF/nucc_bylaws.pdf. The AMA also has a “point and click” licensing fee for reading about CPT on the internet. The CMS describes the “point and click” license in its manual: https://www.cms.gov/manuals/downloads/clm104c23.pdf. Here is an example of the AMA gatekeeper in action: https://www.highmarkmedicareservices.com/cptdisclaimer.html.
The AMA needed only the income it received from its exclusive coding book contract, and the perception in the media that it is the primary mouthpiece for physicians, to disregard the majority of American doctors and openly support the President’s health care reform law back in 2010. At the heart of the AMA’s power structure are community doctors who rise up through the ranks of county and state medical societies as representatives to the national AMA body. These doctors help to promote an agenda that is out of step with America’s mainstream, community physicians. Many of these doctors are paid with trickle-down AMA monies to campaign on behalf of the AMA and its agenda.
Feeling betrayed by their own ‘representatives’, many doctors in America have already opted out of participation in Medicare and Medicaid; many more will follow. And most will not accept patients with an ‘Obamacare’ card in 2014 if they have a choice. Physicians will restrict their practice hours and consider retiring early. The sad reality behind the curtain of backroom deals cut by the AMA and the Obama administration is that this ill-conceived legislation will cut payments to specialist doctors, impose onerous new regulations and restrictions, and literally destroy thousands of medical practices over the next decade in our nation. The next generation of Americans cannot expect the same level of medical care as we enjoy today.
The shocking goal of the Obama-AMA alliance has been to force the expansion of non-physician “extenders,” demote doctors to mere “healthcare providers,” and edge the nation toward a European-style medical nightmare. We are already witnessing the beginning of the end of the grand American medical system, as corporations are dropping their own health plans due to increased costs, increased regulations, and additional taxes. This will not help a stagnant job market.
Adding insult to injury, Obamacare contains no tort reform, the area of greatest concern to physicians as the unnecessary practice of defensive medicine creates wasted time and resources and takes attention away from the care of patients. The only true “protection” inherent to the ‘Affordable Care Act’ is for trial lawyers, who are explicitly identified as a protected group in the new law.
The AMA did not do its job of representing America’s physicians, and this was obviously a coordinated, planned scheme to protect their own corporate self-interests. If the AMA had acted ethically and responsibly, then the American people and their representatives in D.C. would have known that most doctors never supported this ill-conceived legislation.
My military colleague summed up the movement in America toward socialized medicine like this: “if the government truly thinks that unsupervised RNs, nurse anesthetists and physician assistants, working exclusive of free-market competition and advances, can perform at the same level of competence, experience and quality as physicians, then we should leave them to their own devices. In fact, let the foolhardy start facilities staffed only with the least expensive, non-physician ‘providers’ and allow them to operate alongside traditional, physician-led institutions. Let’s see then where the public chooses to place their trust and their lives.”
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Bill Gunderson 
