Healthcare...is it a "good/service" or an inalienable "right"

[DocEspana]

Same way I did. I expect @7starmantis to chime in shortly.

Why would you do this....

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[deleted480308]

Well that's simply not true if you plan to practice in the US. The AMAs code of ethics is a legal standard. Aka, you can be sued for actions which do not comply with it of there is damage to a patient even if your actions are otherwise defensible.

If you don't like that, change it. The AMA is currently accepting open comments from the Internet on this exact document.

You misunderstand my point....the AMA may indeed have influence over my legal reality. They have nothing to do with ethical reality.

 

[DocEspana]

You misunderstand my point....the AMA may indeed have influence over my legal reality. They have nothing to do with ethical reality.

It's awfully fuzzy when theyve expressed opinions on pretty much every ethical situation and their opinions are legally enforceable.

You are free to mutter under your breath that you disagree with it, but your muttering will be happening as you comply with their decisions on ethics. Indignation is so much less relevant than compliance when you argue "they don't get to make ethical decisions for me"

 

[deleted480308]

It's awfully fuzzy when theyve expressed opinions on pretty much every ethical situation and their opinions are legally enforceable.

You are free to mutter under your breath that you disagree with it, but your muttering will be happening as you comply with their decisions on ethics. Indignation is so much less relevant than compliance when you argue "they don't get to make ethical decisions for me"

They don't make ethical decisions, they influence legal force.....those are drastically different things. Writing "ethics" at the top of the page doesn't make it any more ethical. A concept is either ethical or it isn't and getting government to enforce the concept is irrelevant to that reality.

 

[Birdstrike]

Healthcare is not a "right." Healthcare is comprised of goods and services. If healthcare is a right, then another person has a right to your labor and service for free. Another person has no more "right" to my labor, than I have to the services of a chef at a restaurant or the goods (water) of a bottled water company. Food and water are no more a "right" than healthcare. You don't lay your water bill, it gets turned off. You don't have cash for a burger, you don't eat.

You cannot have a "right" to the product of someone else's goods and services, in a free society. Once you make your workday, workweek, work hour someone else's "right," you my friend, are f¥€#¥d.

Healthcare as a "right," is a communist/socialist concept and propaganda/marketing tool. It sounds compassionate and caring on the surface, but is oppressive as played out in reality. Want to work for less? Want to work for more hours for no more (likely less) pay? Want to have no control over your work life, practice quality, and career? Then cede yourself, your services and your skills to someone else as their, not YOUR, right.

 

[DocEspana]

For @sb247 you may be interested to know the common assumption that the AMA is in any way a liberal organization is laughably wrong. The 2009/2010 PPACA vote was a literal one year coup due to a conscious effort of the medical student section, resident and fellow section, and young physicians section (who collectively make up about 30% of votes) to massively increase their presence in the meeting just prior to the vote (and carrying into the vote) specifically for this vote. There has been a huge backlash of conservative leadership rushing back into the organization again to prevent this from happening again.

The AMA is soundly conservative and has been for nearly every year for the last few decades except for one strategically timed blip. Evert single meeting the AMA nearly rescinds their support for "legal policies that would provide insurance coverage to as many Americans as possible" but 1) that phrasing is actually not that bad and 2) it would be horrible politics to do with a sitting president around who can rescind the AMAs influence elsewhere.

If you want to actually see the AMA continue to be the conservative near-monolith it's historically been you may want to join soon. Years of the average conservative doctor jumping ship because they believe their own incorrect rhetoric without ever actually checking reality at all have left the AMA primed for another liberal coup which is expected to happen in a little less than a year, just in time for the next election and the first few months of that presidents term.

 

[deleted480308]

For @sb247 you may be interested to know the common assumption that the AMA is in any way a liberal organization is laughably wrong. The 2009/2010 PPACA vote was a literal one year coup due to a conscious effort of the medical student section, resident and fellow section, and young physicians section (who collectively make up about 30% of votes) to massively increase their presence in the meeting just prior to the vote (and carrying into the vote) specifically for this vote. There has been a huge backlash of conservative leadership rushing back into the organization again to prevent this from happening again.

The AMA is soundly conservative and has been for nearly every year for the last few decades except for one strategically timed blip. Evert single meeting the AMA nearly rescinds their support for "legal policies that would provide insurance coverage to as many Americans as possible" but 1) that phrasing is actually not that bad and 2) it would be horrible politics to do with a sitting president around who can rescind the AMAs influence elsewhere.

If you want to actually see the AMA continue to be the conservative near-monolith it's historically been you may want to join soon. Years of the average conservative doctor jumping ship because they believe their own incorrect rhetoric without ever actually checking reality at all have left the AMA primed for another liberal coup which is expected to happen in a little less than a year, just in time for the next election and the first few months of that presidents term.

I actually understand and in some ways agree with your perspective on how to approach changing what is the largest voice in medicine. I vastly prefer the AAPS but they simply don't have the same influence. It doesn't change my thoughts on the ethical vs force of law breakdown.....but I'm practical enough to also want to address the force of law part

 

[DocEspana]

They don't make ethical decisions, they influence legal force.....those are drastically different things. Writing "ethics" at the top of the page doesn't make it any more ethical. A concept is either ethical or it isn't and getting government to enforce the concept is irrelevant to that reality.

You're going to have a real hard time witg the idea of surrogate markers vs patient centric outcomes.

Edit: this comment alone is funnier. All the other stuff is getting too heavy.

 

[deleted480308]

You're going to have a real hard time witg the idea of surrogate markers vs patient centric outcomes.

Edit: this comment alone is funnier. All the other stuff is getting too heavy.

Ugh, don't even get me started haha...

 

[Doctor Bob]

This is a part of being a physician, and upholding the ethical code of a physician.

I guess I'm not a physician then.

 

[VA Hopeful Dr]

It is because of this understanding that the government protects your livelihood, punishing anyone who would dare practice your craft without a medical license, i.e. quacks. This is why you are not competing with witch doctors.

This understanding is also why the government and society allows us physicians to (within certain bounds) regulate ourselves. This fact is also why we are considered professionals.

This is the single most incorrect thing I have read in weeks on this site.

The reason the government protects us has nothing to do with us, its about protecting the public. That is why it is illegal to practice medicine without a license. Period, full stop.

 

[Mad Jack]

Yes, you did. And I think you should have sort of expected this, which is why I wish that we would discourage talk of religion and politics in the EM sub-forum. I certainly don't talk about religion and politics at work, and this is sort of like work (i.e. same kind of crowd).

To answer your question:

A majority of American physicians are fiscally conservative. According to one poll, 77% of male physicians and 69% of women identify that way. If you are asking anecdotal data, my personal experience confirms this: most physicians I've worked with seem to lean fiscally conservative. This thread and forum also indicate that to me.

I suspect there is a general drift toward fiscal conservatism as a medical student turns into a resident and then an attending, once the salary increases a lot and the physician pays more in taxes. (This poll shows that a majority of medical students are liberal, but I don't know if they broke it down to see what the breakdown is on social vs fiscal.)

This is a funny Onion article which I think would characterize many physicians (although hyperbolically so):

Fiscally I'm A Right-Wing Nutjob, But On Social Issues I'm ****ing Insanely Liberal

I think it makes obvious sense why physicians would lean fiscally conservative. I am very liberal, and vote Green Party (Dr. Jill Stein in this election cycle), and find Bernie Sanders to be the lesser of the evils. Yet, a part of me is also fearful that my salary will take a hard hit if Sanders were elected. Additionally, I joke that I am a Green Party liberal at heart, but my patients often push me to become Republican. This is because we see lots of patients abusing the system, and we ourselves are overworked, so this does start oneself to take a very negative opinion of the "lower segments of society." This must be acknowledged.

I work clinically in hickville but hold an academic position at an ivory tower institution. I joke that hickville pushes me to become conservative, whereas the ivory tower pulls me back to the liberal elitism I'm comfortable with.

Anyways, back to your actual question and more seriously: As for whether or not healthcare is a right or not, this is a hotly debated issue and since nobody here can speak for God or some higher power, nobody can claim absolute certainty on this issue. Instead, both sides argue their points based on what they believe.

Amongst Americans, the question is often about the Constitution (and the Declaration of Independence, which is often confused for the Constitution). In this regard, the Declaration of Independence states that all men have "unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness," whereas the Constitution argues for a purpose to "promote the general welfare." Liberals and conservatives disagree whether or not welfare, medicare, and/or universal healthcare would fall under the rubric of "Life, Liberty and the pursuit of Happiness" and the general welfare clause.

However, over U.S. law is international law, which recognizes the right of health. The right to healthcare is a universally recognized human right, so declared by the United Nations Universal Declaration of Human Rights, which the United States is a signatory to. Additionally, the United States is a signatory of the World Health Assembly resolution 58.33, which also states the same.

The entire "free world" agrees to this, and the United States is pretty much the only country in this group *not* to provide universal health care coverage. In fact, we are dead last. We Americans tend to take human rights very seriously, especially when human rights abuses take place in other countries--especially those considered enemy states--so there is a strong argument for consistency. If we cite the UN Universal Declaration of Human rights when punishing other countries, then we ought to follow it ourselves.

Further, the United States is among the wealthiest countries in the world, if not THE wealthiest country in the world. If all these other Western countries with less resources than us can provide universal health coverage, then why can't we? Further, due to its inefficient patchwork system, the U.S. spends more than double what other Western countries do on healthcare. So, we spend way more, and get way less.

As for the expense, which the OP alluded to:



Proponents of universal healthcare (UHC) argue that UHC would actually be almost cost neutral or even save money for individual Americans. It is tempting to scoff at this idea, because how can one get something for nothing? Admittedly, government spending would have to increase to support UHC, to the tune of an estimated 70 billion dollars. (I am, however, seeing conflicting figures. I've seen a much higher amount here, to the cool tune of 562 billion dollars.)

However, what is meant by this claim--that Americans would actually *save* money through UHC--is that although government spending will increase (and thus Americans would pay more taxes to the government), Americans are already paying *more* to private insurance companies. So, there would be a net savings (paying more to the government but none to private insurance companies). The net savings for the people of the United States is estimated at 600 billion dollars. Subtracting the cost of higher taxation ($562 billion) and you are left with a net savings of some 38 billion dollars.

There is a desire to demonize the government, and I think a lot of that is justified. However, private insurance companies are a far greater evil. Further, going to a single payer system would save in all sorts of administrative costs. Right now, a whopping $294.3 billion is spent on administrative costs, or 31 cents out of every dollar spent on healthcare. In single payer systems, the percentage is much, much lower: 31% in USA vs 16.7% in Canada.

Further, it is not the case that the United States cannot afford universal healthcare. As stated above, the United States is among the richest countries in the world, if not the richest. The question is where we choose to spend that money. The military budget sits at a hefty 610 billion dollars, dwarfing that of every other country on earth (and more than the next seven countries COMBINED). Just the wars in Afghanistan and Iraq cost a whopping 4-6 trillion dollars.

The yearly price of 70 billion dollars could easily be subtracted from the 610 billion dollars given to the military, providing universal healthcare to all Americans--and the U.S. military would still spend way, way more than any other country on earth on its military.

As a physician, I realize that universal healthcare would probably result in the decrease of my salary. So, I have a personal reason to dislike this idea, even if I think it is the right thing to do. To be clear, I don't actually think doctors are paid too much. We are among the most educated and productive classes in society, and we should be compensated adequately for that.

Further, if doctor salaries decrease to bring them in line with other countries in the Western world, then education should also be free. After all, the high salary of US doctors contrasts with the huge amounts of student debt we acquire. On that note, I support free college for all, which would cost 62.6 billion dollars, which I also think should be taken from the military. In this regard, I support the bumper sticker-worthy saying:

"It will be a great day when our schools get all the money they need and the air force has to hold a bake sale to buy a bomber."

It is not then a question about whether we have the money or not, but where we are willing to spend it. Green Party sort of liberals would rather spend it on universal healthcare, education, humanitarian work, the environment, etc. While conservatives argue for fiscal conservatism, the reality is that they want to spend the same money but on the military. (The exception to this was Ron Paul.) The libertarian Rand Paul, for example, actually recently proposed a $76.5 billion increase in the military budget ($190 billion in two years). As the article notes:

In an olive branch to defense hawks hell-bent on curtailing his White House ambitions, the libertarian Senator introduced a budget amendment late Wednesday calling for a nearly $190 billion infusion to the defense budget over the next two years—a roughly 16 percent increase... Paul’s amendment brings him in line with his likely presidential primary rivals​

That 76.5 billion dollar could go to universal college, which costs 62.6 billion dollars. It is something interesting that conservative voters would often support military expenditures and costly wars, but not education or healthcare.

I think it is tempting to blame the 3-PPD smoker with end stage COPD for his own condition. Leaving aside the issue of smoking being prevalent in poverty stricken areas, we must ask about the five year old child with a life threatening illness whose parents did not pay for health insurance. It is an inconsistency to argue that the five year old should be covered ...



If that is truly the case, then would it not be "theft" to take your money in taxes to cover children? If one takes a consistently libertarian position, then one would have to deny healthcare to a child--even the five year old who comes down with cancer. After all, strict libertarians would want to deny public education to even school children. It takes taxes ("theft") to fund public elementary, junior high, and high schools. And, at one point in time in our history, children worked for a living, before progressive laws sought to ban child labor and endorse public education.

If it can be justified to take your money in taxes to pay for the child, then the matter has been established: it is sometimes justified to take your money in taxes to pay for the general welfare of your fellow human.

In a pure libertarian world, if someone's house burns down, the fire brigade would do nothing since the person failed to pay private fire insurance. In this situation, if you did not do due diligence and buy fire insurance, then you deserve for your house to burn down.

If the reasonable human agrees that in this scenario, the fire brigade should be a public service paid for by taxes, then how much more precious are lives than houses?

Look, we may not like universal health care or taxes because it will hurt us economically, but let's at least be honest about the reasons we don't like it, instead of hiding behind libertarianism, which I think is often used as a system of justification by rich people to hoard their wealth.

A net savings of 38 billion? That amounts to a mere $105 savings per person, at the cost of having the government run health care, after which our system and livelihoods will amount to little more than congressional bargaining chips. "Oh, you want pre-K education? We can pay for that by cutting health care salaries 3%."

It's quite incorrect to state that this is about the taxes for physicians. For your average high-earning individual, that would be true. But for current and future physicians, there are much more serious issues at play. The average small business owner isn't risking a government takeover of his livelihood every time he votes Democrat, he's just risking a small increase in his marginal tax rate. We have to put our entire future on the line- how we'll be reimbursed, our tax rates, the conditions under which we will work, etc. That's a big number of reasons I can't vote democrat in any congressional or senatorial election.

 

[Mad Jack]

Not going to contribute much other than to say that the average before tax salary in the U.S. Is 50k. To say 10k for surgery is "inexpensive" is misguided. That's a fifth of a persons income in a given year. And the federal poverty level for a couple is 15k so you're literally using their entire years salary on a surgery if they don't have insurance. So while it may seem somewhat cheap to us, to the average person who doesn't have insurance, needing something like surgery can bankrupt them.


As far as the topic of right vs privilege, is it a right to bear arms or a privilege? Cause we definitely call it the first, but it can be taken away if you're a felon etc. it gets down to semantics. Do I think people should get care regardless of their ability to pay? Yes. To me, that makes it a right.

And how would you force people to provide such care? Personally I would opt out of the insurance system entirely if it went single payer, as would many physicians. No one has a right to my work, or to utilize the skills I have spent years and a over a half million dollars in loans and opportunity cost to master. How do you propose dealing with a large efflux of physicians from the system if you declare people to have a right to it regardless of ability to pay?

 

[Mad Jack]

No, this is not correct. However, if a person happened to sustain cardiopulmonary arrest outside your door, you would be expected to come to her rescue if the conditions I outlined above are met, i.e. your failure to intervene would result in harm/death, you have a good chance of success, etc.

Further, there is some complexity here. You must provide care if you are the only one who can do so. However, if someone else can adequately do the job and agrees to do it, then this discharges you of your responsibility. So, if EMS arrives on the scene and takes over, your ethical obligation is over.

Ethics is different than law. Ethics are meant to be at a higher standard than the law, which is the bare minimum. If, for example, the zombie apocalypse occurs, and the government collapses and there is complete anarchy--even then your ethical obligation to provide medical care would exist, if the conditions I outlined are met. This is a part of being a physician, and upholding the ethical code of a physician.

Again, you are not a mechanic. You are part of a noble profession. This, by the way, is part of the social contract between physicians and society--which you benefit from and obtain all your life earnings and prestige from. From the AMA Journal of Ethics:

The obligations of physicians necessary to sustain the contract were understood and passed on by respected role models. For its part, society understood what it wanted from those responsible for the care of the sick. Societal obligations were present, but less clear. Society granted physicians status, respect, autonomy in practice, the privilege of self-regulation, and financial rewards on the expectation that physicians would be competent, altruistic, moral, and would address the health care needs of individual patients and society [6]. This "arrangement" remains the essence of the social contract [between physicians and patients].
​

It is because of this understanding that the government protects your livelihood, punishing anyone who would dare practice your craft without a medical license, i.e. quacks. This is why you are not competing with witch doctors.

This understanding is also why the government and society allows us physicians to (within certain bounds) regulate ourselves. This fact is also why we are considered professionals.

Society has broken their obligation to us, therefore our contact with society is at an end. We have lost our autonomy, they do not value our competence, and respect and prestige are a thing long since faded. They can't have their cake and eat it too, stripping away everything it means to be a professional, forcing us into a model of care with a lack of autonomy at threat of loss of licensure, with dwindling compensation and respect, and yet still expect us to maintain our end of the bargain.

 

[jdh71]

Well that's simply not true if you plan to practice in the US. The AMAs code of ethics is a legal standard. Aka, you can be sued for actions which do not comply with it of there is damage to a patient even if your actions are otherwise defensible.

If you don't like that, change it. The AMA is currently accepting open comments from the Internet on this exact document.

The AMA can get ****ed. The don't represent me. Hell they barely represent any of us. It's some kind of stupid conceit that they even think they are relevant.

 

[GeneralVeers]

I agree that ethical standards apply to us to while at work. When I'm not at work, and at home in my civvies, I have the same LEGAL obligations that any other private citizen has. I have no moral, ethical, or legal duty to provide people goods, services, or my knowledge beyond what would be expected of a layperson.

 

[DocEspana]

And how would you force people to provide such care? Personally I would opt out of the insurance system entirely if it went single payer, as would many physicians. No one has a right to my work, or to utilize the skills I have spent years and a over a half million dollars in loans and opportunity cost to master. How do you propose dealing with a large efflux of physicians from the system if you declare people to have a right to it regardless of ability to pay?

I stopped reading the thread at this point. I'm saying this not because you have some insane comment, but because my comment it quite simple and if someone already said it I want to apologize for not reading further.

If you opt out you're effectively the same as a physician who did level 3, a year if residency and requested a license... aka... you'll be able to run a cash business or work for another doctor (almost excusively this ends up being working at a nursing home or working as the assistant to one of these mega-doctors who just does surgery and outsources all pre op and post op exams). And that's it.

I will tell you... almost no one will opt out when that is the case. Unless you have a great method to start a concierge practice (which the AMA profiled recently as one of the most volatile and likely to fail business models) you're taking a massive pay hit by opting out of insurance. And as someone who works extensively with pissed off old doctors who hate change and opt out of *everything*.... the opt out rate would be miniscule, and not a phenomenon worth reacting to. It's the early retirement rate that would rise.

 

[DocEspana]

The AMA can get ****ed. The don't represent me. Hell they barely represent any of us. It's some kind of stupid conceit that they even think they are relevant.

They're relevant as long as you have no other representation worth squat out there where the laws are made. You can curse them and continue to have no voice in politics or ypu can try to control them and actually make the changes you want.

This is really where you and I differ. You will take a principled stance and say **** the corrupt powers. Your sphere of influence literally ends at your friends and this websites SPF. Yoi can be as insular and self reliant as you want, but at the end of the day the government is going to come and tell you what to do in a voice more powerful than your own. I say "principles mean nothing, results are all that matters" and "I can control this" and I become relevant and powerful in the organization. I may swim with the sharks, but my ideas have become national law before and will continue to become national and state law for the foreseeable future since I want my sphere of be broadcast through the only group the lawmakers listen to.

You can curse the darkness all you want. You accomplish nothing. I embrace the partially corrupted system and try to make the good parts of it shine, and I can actually accomplish tangible things. Please. Keep staying away from the AMA. I want to keep being able to help write bills that go to Congress without input from the other half of the political spectrum. There are more 5han enough insanely right wing people in the AMA as it is.

 

[DocEspana]

With all of that said.... health care is still a good or privilege.

It may be a public good. It may be something that you get regardless of ability to pay INITIALLY, but if you cannot pay afterwards your access gets severely limited. Everyone has access to electric... but if you decide to not pay for a bit then they don't have to keep giving it. But it's not like you have to pre pay or prove your ability to pay for electric first. Seems to be similar to our medicine system, particularly on the EM end.

 

[deleted480308]

With all of that said.... health care is still a good or privilege.

It may be a public good. It may be something that you get regardless of ability to pay INITIALLY, but if you cannot pay afterwards your access gets severely limited. Everyone has access to electric... but if you decide to not pay for a bit then they don't have to keep giving it. But it's not like you have to pre pay or prove your ability to pay for electric first. Seems to be similar to our medicine system, particularly on the EM end.

I've had 10 addresses and had to pay a deposit for electricity at every single one of them.....where have you lived that power just shows up with no amount of money changing hands?

 

[jdh71]

They're relevant as long as you have no other representation worth squat out there where the laws are made. You can curse them and continue to have no voice in politics or ypu can try to control them and actually make the changes you want.

This is really where you and I differ. You will take a principled stance and say **** the corrupt powers. Your sphere of influence literally ends at your friends and this websites SPF. Yoi can be as insular and self reliant as you want, but at the end of the day the government is going to come and tell you what to do in a voice more powerful than your own. I say "principles mean nothing, results are all that matters" and "I can control this" and I become relevant and powerful in the organization. I may swim with the sharks, but my ideas have become national law before and will continue to become national and state law for the foreseeable future since I want my sphere of be broadcast through the only group the lawmakers listen to.

You can curse the darkness all you want. You accomplish nothing. I embrace the partially corrupted system and try to make the good parts of it shine, and I can actually accomplish tangible things. Please. Keep staying away from the AMA. I want to keep being able to help write bills that go to Congress without input from the other half of the political spectrum. There are more 5han enough insanely right wing people in the AMA as it is.

I guess I can't do much about who the idiots listen too.

 

[DocEspana]

I guess I can't do much about who the idiots listen too.

I want to control the idiots.

But if they ask, tell them I said I love their service to our country and to keep up the good work. Also that I have something to discuss with them over a steak dinner and a briefcase full of bills.

 

[DocEspana]

I've had 10 addresses and had to pay a deposit for electricity at every single one of them.....where have you lived that power just shows up with no amount of money changing hands?

Hudson Valley NY
North Jersy
Long Island
New York City.

To be fair three companies supply the electric in those four areas. But in all three cases you simply call up and get electricity and it turns on a few hours/days later. All they want is your street address, e-mail address, and name. Your first bill shows up >1 month later based on what you use.

I understand in other areas that your electricity is sometimes "prospectively" charged based on what they think you will use in the next 30 days? That seems bonkers to me.

 

[jdh71]

I want to control the idiots.

But if they ask, tell them I said I love their service to our country and to keep up the good work. Also that I have something to discuss with them over a steak dinner and a briefcase full of bills.

I'm not convinced I want you controlling anyone either . . .

 

[VA Hopeful Dr]

I stopped reading the thread at this point. I'm saying this not because you have some insane comment, but because my comment it quite simple and if someone already said it I want to apologize for not reading further.

If you opt out you're effectively the same as a physician who did level 3, a year if residency and requested a license... aka... you'll be able to run a cash business or work for another doctor (almost excusively this ends up being working at a nursing home or working as the assistant to one of these mega-doctors who just does surgery and outsources all pre op and post op exams). And that's it.

I will tell you... almost no one will opt out when that is the case. Unless you have a great method to start a concierge practice (which the AMA profiled recently as one of the most volatile and likely to fail business models) you're taking a massive pay hit by opting out of insurance. And as someone who works extensively with pissed off old doctors who hate change and opt out of *everything*.... the opt out rate would be miniscule, and not a phenomenon worth reacting to. It's the early retirement rate that would rise.

Me and the 5000 other DPC doctors out here currently disagree with your thinking here

 

[Mad Jack]

I guess I can't do much about who the idiots listen too.

You could become the one the idiots listen to.

 

[jdh71]

You could become the one the idiots listen to.

No it's actually a good point and really Doc's point. It's juts a sad ****ing point. So . . . in order to have a say that the idiots will listen to, it appears I will have to not only join but get involved in an organization that most of us don't belong to and doesn't seem to represent any of us because the idiots think it does?? FFS. It's like taking crazy pills. But what is a pragmatic man to do?? Hmm? My work will pay for my AMA memembership, so maybe I'll sign up and try and figure out how to get active. Though, I don't know what I'm going to do with the stacks of JAMAs I'll have that I always mean to read but just never do. It might be too much PTSD from medical school than I can deal with . . .

 

[Mad Jack]

Though, I don't know what I'm going to do with the stacks of JAMAs I'll have that I always mean to read but just never do. It might be too much PTSD from medical school than I can deal with . . .

They make good kindling.

No it's actually a good point and really Doc's point. It's juts a sad ****ing point. So . . . in order to have a say that the idiots will listen to, it appears I will have to not only join but get involved in an organization that most of us don't belong to and doesn't seem to represent any of us because the idiots think it does?? FFS. It's like taking crazy pills. But what is a pragmatic man to do?? Hmm?

I plan on being active. The only way to turn this ship around is for the right people to take hold of the wheel. It's a bunch of idiots because all the good people bailed, and they're all that is left. Reasonable people with sound policy positions need to make a serious influx into the AMA, or it's going to be steered entirely by academic liberals and medical students that are too idealistic to know what the hell is good for them.

 

[DocEspana]

Reasonable people with sound policy positions need to make a serious influx into the AMA, or it's going to be steered entirely by academic liberals and medical students that are too idealistic to know what the hell is good for them.

You'll be pleasantly surprised to know the AMA is driven almost entirely by neoconservatives over the age of 50. The younger societies make up about 33% of the voting power and are probably in a 66/33 left-right split. But the other 66% is probably 20/80 left-right with super conservatives making up a huge part of it.

The AMA almost came out against women's rights in November. They were considering removing support for abortions. This is a legitimate debate had. They nearly remove support twice a year for "support of affordable insurance" because that phrase happens to apply to PPACA. Despite the actual policy being common sense "good policy" and in reality having nothing to do witg PPACA except that it happens to support an element of it.

The AMA is an extremely conservative group. The last president gave a 30 minute speech where he openly longed for the days of reagan "when politicians stayed out of politics" ans discussed the importance of physician presence in the next election "to right the ship"

A liberal ama occurs about every 8 years for one year. The younger sections know they cant maintain control for long, so they plan in 8 year cycles around national elections. Outside of that, it's a fairy tale old doctors tell to young doctors to scare them but is no more real than the monsters under your bed.

 

[GeneralVeers]

I can't ever support the AMA after their support of PPACA. There is nothing affordable about the care provided in this act. I lost my own health insurance and now pay about $100 more per month for vastly inferior coverage through the exchange. In essence the law made insurance MORE expensive for the majority of Americans, in exchange for covering pre-existing conditions, and expanding medicaid to the minority. Not a great deal on balance.

 

[DocEspana]

I can't ever support the AMA after their support of PPACA. There is nothing affordable about the care provided in this act. I lost my own health insurance and now pay about $100 more per month for vastly inferior coverage through the exchange. In essence the law made insurance MORE expensive for the majority of Americans, in exchange for covering pre-existing conditions, and expanding medicaid to the minority. Not a great deal on balance.

<shrug>. My suggestion to you is keep complaining to places that dont matter, or join up with the only place that makes a difference and can actually influence policy and perhaps have a lasting legacy of reform. The PPACA support is more along the lines of support of "affordable healthcare for all americans" which in reality is nothing like the PPACA, but everyone likes to politicize the policy as being pro-PPACA. And similarly that wording only occurred because of a years-in-the-making plan to have liberal leaning leadership in 2008-20009 in an organization that is overwhelmingly conservative nearly all the time except for brief flahses of left leaning leadership.

Given that I make my bones on actually going to congress and arguing my point there; every time someone says "I cant support the AMA" I immediatley ignore the rest of their comment because its equivalent to forfeiting your rights to have an opinion in medical politics. The more people who forefeit, the easier it is for the AMA to actually be a liberal organization. and for the record, the AMA is one of the most solidly conservative organizatons out there, but the conservatives there are disillusione and the liberal minority is galvanized so they *will* make a push in november and *may* hold power for a bit if more conservatives flee from the organization. Prior to very recently the AMA followed a very predictable pattern of liberal influx every 4-8 years (based on realistic chances of new president, regardless of party) and staunchly conservative the other 75-87.5% of the time. For decades its been this way. If you don't support the AMA you're making it easier for me to make all the policies in the future. And despite what you might think, people like me lose 90% of our arguments in the AMA. We literally can only defeat absurd policies like "the AMA opposes Roe v Wade decision." And super frequently we pass stuff like "The AMA supports repeal of all oversight by the federal government of physician performance" which.... makes sense until you realize its not just against physician metrics, but against ANY federal action by then government on deliquent and inferior physicians.

So if you dont want to support the AMA, go right ahead. I am glad to have one less person in the way of people like me making policy you have to follow. Opting out of the AMA is exactly what I want you to do, beause its the only people the federal government listens to. The more who opt out, the easier it is to overcome the (previously overwhelming, now just...) majority conservative presence in the AMA.

 

[weasel23]

<shrug>. My suggestion to you is keep complaining to places that dont matter, or join up with the only place that makes a difference and can actually influence policy and perhaps have a lasting legacy of reform. The PPACA support is more along the lines of support of "affordable healthcare for all americans" which in reality is nothing like the PPACA, but everyone likes to politicize the policy as being pro-PPACA. And similarly that wording only occurred because of a years-in-the-making plan to have liberal leaning leadership in 2008-20009 in an organization that is overwhelmingly conservative nearly all the time except for brief flahses of left leaning leadership.

Given that I make my bones on actually going to congress and arguing my point there; every time someone says "I cant support the AMA" I immediatley ignore the rest of their comment because its equivalent to forfeiting your rights to have an opinion in medical politics. The more people who forefeit, the easier it is for the AMA to actually be a liberal organization. and for the record, the AMA is one of the most solidly conservative organizatons out there, but the conservatives there are disillusione and the liberal minority is galvanized so they *will* make a push in november and *may* hold power for a bit if more conservatives flee from the organization. Prior to very recently the AMA followed a very predictable pattern of liberal influx every 4-8 years (based on realistic chances of new president, regardless of party) and staunchly conservative the other 75-87.5% of the time. For decades its been this way. If you don't support the AMA you're making it easier for me to make all the policies in the future. And despite what you might think, people like me lose 90% of our arguments in the AMA. We literally can only defeat absurd policies like "the AMA opposes Roe v Wade decision." And super frequently we pass stuff like "The AMA supports repeal of all oversight by the federal government of physician performance" which.... makes sense until you realize its not just against physician metrics, but against ANY federal action by then government on deliquent and inferior physicians.

So if you dont want to support the AMA, go right ahead. I am glad to have one less person in the way of people like me making policy you have to follow. Opting out of the AMA is exactly what I want you to do, beause its the only people the federal government listens to. The more who opt out, the easier it is to overcome the (previously overwhelming, now just...) majority conservative presence in the AMA.

^^this is pretty interesting. so should I as a fairly conservative medical student join the AMA (it's cheap for me). Does joining give you a say if you don't get super involved/go to meetings? Would love to hear anyone's answer, not just @DocEspana

 

[deleted480308]

^^this is pretty interesting. so should I as a fairly conservative medical student join the AMA (it's cheap for me). Does joining give you a say if you don't get super involved/go to meetings? Would love to hear anyone's answer, not just @DocEspana

In reality, no. It just gives those who hold the mic the chance to claim one more person agrees with them. The AMA issues statements under the weight of it's membership number, not the weight of members that agree with each statement.

 

[HoosierdaddyO]

So than how does one get involved and hold this "power" within the AMA lol? I'm a firm believer of "be the change you wish to see"., but not really sure how to get started.

 

[DocEspana]

^^this is pretty interesting. so should I as a fairly conservative medical student join the AMA (it's cheap for me). Does joining give you a say if you don't get super involved/go to meetings? Would love to hear anyone's answer, not just @DocEspana

You need to climb up the rungs a bit to have any real influence. The MSS (medical student section) is full of people who do it for their CV and not to make a difference, but they elect people to the real AMA whereyou can make a difference.

From a legit neutral point of view, yes... if you want to maintain an AMA with a right leaning view, you should joint it because it has never been less solid in its conservative vlaues than now. The narrative of "oh the AMA has abandoned conservatives" is 1) laughably false and 2) exactly what people like me want. Please. Flee the AMA.

From a less neutral POV. No. I dont want conservative students to join the AMA. I have enough insane neo-cons and regular conservatives to argue with at every meeting, I don't need more.

 

[DocEspana]

In reality, no. It just gives those who hold the mic the chance to claim one more person agrees with them. The AMA issues statements under the weight of it's membership number, not the weight of members that agree with each statement.

Oh thats bull****. They make statements based on the breakdown of the voting populace.The voting populace is the number of people who are willing to go to the meetings and get elected as a voting member. We've donet the studies. The AMA voting body is MUCH more conservative than the overall physician body. Both are conservative, but the AMA voting body is like 70-30 and the overall physican body is like 55-45. You're all just bitchy because the left leaning side knows they are perpetually outnumbered so they lay low and organize for specific events like presdential elections and we actually got a SINGLE victory in the last decade.

 

[DocEspana]

So than how does one get involved and hold this "power" within the AMA lol? I'm a firm believer of "be the change you wish to see"., but not really sure how to get started.

Go to a meeting. Seem even vaguely interested. At the end of the meetig (really day 3 of 4. its always four day events) they ask who wants to run for elected positions to the main body. If youre from a smaller state you'll run unconstested. If you're from a bigger state (whats a big state depends on if youre a student, a resident, or a young physcian) you'll have to play politics since multuiple people will be running for it

 

[deleted480308]

Oh thats bull****. They make statements based on the breakdown of the voting populace. We've donet the studies. The AMA voting body is MUCH more conservative than the overall physician body. Both are conservative, but the AMA voting body is like 70-30 and the overall physican body is like 55-45. You're all just bitchy because the left leaning side knows they are perpetually outnumbered so they lay low and organize for specific events like presdential elections and we actually got a SINGLE victory in the last decade.

None of the position papers or announcements I've seen started with "45% of us think the following is insane but majority rules so yolo".

The AMA purports to speak for all of us (implying all physicians, not just AMA members)but repeatedly takes positions on things that not remotely all of us agree on.

 

[DocEspana]

None of the position papers or announcements I've seen started with "45% of us think the following is insane but majority rules so yolo".

The AMA purports to speak for all of us (implying all physicians, not just AMA members)but repeatedly takes positions on things that not remotely all of us agree on.

well because firstly... if they did that they'd all start with "70% of us agree" or "55% of us agree". Outside of the EXTREMELY TEPID edorsement of somethig SIMILAR to the PPACA, I've never seen the AMA do much of anything that would be considered liberal. And this is excluding your particular hardline libertarian stance since your libertarianism is on the right, but also exists on a wholly different axis from the casual "left right" axis. The AMA consistently and nearly always comes out with either conservative opinions or with "this is just common sense defense of medicine" opinions.

 

[DocEspana]

None of the position papers or announcements I've seen started with "45% of us think the following is insane but majority rules so yolo".

The AMA purports to speak for all of us (implying all physicians, not just AMA members)but repeatedly takes positions on things that not remotely all of us agree on.

Plus... i understad what youre saying... but seriously... every political system I know of in the world works on a majority rules type system. Why would they be any different?

 

[GeneralVeers]

Actual DocEspana I've gone to Capitol Hill with ACEP lobbying the last 3 years. I know how it works. ACEP has done far more to represent our interests (even if they're in the pocket of CMGs) than has AMA.

 

[DocEspana]

Actual DocEspana I've gone to Capitol Hill with ACEP lobbying the last 3 years. I know how it works. ACEP has done far more to represent our interests (even if they're in the pocket of CMGs) than has AMA.

but has ACEP *actually* passed and written laws? Because I myself (not AMA. Not "me and the rest of the crew". Me) have written two bills that made it to law mostly unchanged due to the AMA's connections and, AFAIK, about 12 bills have passed due to direct action of myself an other AMA people placing the bill directly on politicians desks. These arent "hey we want this" and the represetative nods politely and ignores us, or "dont do this" and if it doesn't happen we call it a win regardless of if we caused it or not. If you cannot concretely present evidence you've made a difference (and I assure you, ACEP is among the smallest fish in the medical lobbying sea to the point where I actively decline lobbying with ACEP because it feels totally futile and a waste of my time and I'll lobby with the AOA who are dreadfully bad at lobbying), you havent made a difference except in your own heart.

The caveat is you said you did it in 3 years. My accomplishments, while mostly focused on a 2 year period of 2011-2012, have spanned a lobbying career that began before medical school. So I've been at this longer; since early 2008. Perhaps less efficiently, if you do have some wins to concretely bring home in fewer years. but early on I was just a random congressional aid. I just doubt you do because ACEP is not particularly relevant in DC from what I've gathered.*

*contrast that with the AMA where ACEP has an influence WAY outstripping its representative power balance. ACEP intelligently stuffs the AMA with as many representatives as it can, including the current president of the AMA and multiple leadership positions. Its likely to have another president of the AMA in the 5-6 year mark (which is unheard of in an organization where president is an honor more than an actual job, and as such is rotated between geographic areas and specialties)

 

[GeneralVeers]

but has ACEP *actually* passed and written laws? Because I myself (not AMA. Not "me and the rest of the crew". Me) have written two bills that made it to law mostly unchanged due to the AMA's connections and, AFAIK, about 12 bills have passed due to direct action of myself an other AMA people placing the bill directly on politicians desks. These arent "hey we want this" and the represetative nods politely and ignores us, or "dont do this" and if it doesn't happen we call it a win regardless of if we caused it or not. If you cannot concretely present evidence you've made a difference (and I assure you, ACEP is among the smallest fish in the medical lobbying sea to the point where I actively decline lobbying with ACEP because it feels totally futile and a waste of my time and I'll lobby with the AOA who are dreadfully bad at lobbying), you havent made a difference except in your own heart.

The caveat is you said you did it in 3 years. My accomplishments, while mostly focused on a 2 year period of 2011-2012, have spanned a lobbying career that began before medical school. So I've been at this longer; since early 2008. Perhaps less efficiently, if you do have some wins to concretely bring home in fewer years. but early on I was just a random congressional aid. I just doubt you do because ACEP is not particularly relevant in DC from what I've gathered.*

*contrast that with the AMA where ACEP has an influence WAY outstripping its representative power balance. ACEP intelligently stuffs the AMA with as many representatives as it can, including the current president of the AMA and multiple leadership positions. Its likely to have another president of the AMA in the 5-6 year mark (which is unheard of in an organization where president is an honor more than an actual job, and as such is rotated between geographic areas and specialties)

Yes

 

[deleted480308]

Potentially relevant to our earlier discussions about ethics codes and principles espoused by professional organizations.....