AMA "1 in 7" campaign

[GeneralVeers]

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Members don't see this ad.

If you've seen the AMA ads on TV promoting coverage for the "47 million who are uninsured" you should be worried.

I believe that AMA is not representing the interests of its members with this campaign.

Additionally, their data is incorrect at best.

A recent Nature article examined the breakdown of this "47 million" and came to some interesting conclusions:
http://www.nature.com/ncponc/journal/v5/n2/full/ncponc1046.html

"So, let’s take a look at a rough breakout of the 47 million statistics. First, 12.7 million (27%) of the 47 million are uninsured for only a part of the year in which they are counted, and are, therefore, ultimately insured. This is an issue of portability of health insurance. Second, around 10.34 million (22%) of the 47 million are listed as “not American citizens’’. Surely the solution for this group has more to do with immigration reform than reform of the health-care system? Third, 19% constitute a group of roughly 9 million people, half of whom earn $50–75,000 a year while the other half earn more than $75,000 a year. Many of these individuals are healthy young people who can afford insurance but choose not to buy it. Fourth, a group of about 8 million people (17% of the 47 million) are actually eligible for health insurance under a variety of existing plans but don’t take advantage of them, sometimes owing to ignorance. The lack of insurance in this group is surely a problem of patient education. Finally, 15% make up a fifth group of approximately 7 million people who might actually represent the true “uninsured’’ or those‘‘without insurance whatsoever’’. This situation is certainly a tragedy for a country as rich as the US. When the 47 million uninsured figure, is quoted it implies that all of these individuals represent the fifth group of uninsured individuals, which seems incorrect. It also implies that fixing the problem of the uninsured will fix the problem of access to care when, in reality, they are two separate issues."

 

[WallowaWanderer]

"So, let’s take a look at a rough breakout of the 47 million statistics. First, 12.7 million (27%) of the 47 million are uninsured for only a part of the year in which they are counted, and are, therefore, ultimately insured.

They are not ultimately insured. There are as many be people who had insurance and then lost it as there are people who did not have insurance and gained it. Ask a trauma patient who just landed in the ICU but happened to lose his insurance last month if he is "ultimately insured."

Second, around 10.34 million (22%) of the 47 million are listed as “not American citizens’’. Surely the solution for this group has more to do with immigration reform than reform of the health-care system?

So let's say we were able to really shore up our borders - maybe we could cut that number in half. I think we should still take care of those people - however many of them there are - if they get sick within our country. We depend on illegal aliens to do some of the crappiest jobs in our country - I think we should give them some low level health care. But this is a matter of opinion.

Third, 19% constitute a group of roughly 9 million people, half of whom earn $50–75,000 a year while the other half earn more than $75,000 a year.

That's not a whole lot of money, especially if you live in an expensive area and I bet that the salaries in this study weren't adjusted or cost of living. If you look at the cost of health insurance it's amazing - especially in the private market. What if your employer doesn't carry or offer health insurance? - then you can't go anywhere in the private market to get your pre-existing conditions covered.

Many of these individuals are healthy young people who can afford insurance but choose not to buy it.

If one of these people gets in a car accident or gets cancer, society will pay one way or another. Just because someone made a stupid decision - does that mean we're not, as a society, going to care of him/her?

Fourth, a group of about 8 million people (17% of the 47 million) are actually eligible for health insurance under a variety of existing plans but don’t take advantage of them, sometimes owing to ignorance. The lack of insurance in this group is surely a problem of patient education.

We'll never be able to educate all these people and get them all signed up. Everyone should just be automatically covered - that's my opinion.

Finally, 15% make up a fifth group of approximately 7 million people who might actually represent the true “uninsured’’ or those‘‘without insurance whatsoever’’.

Does it really matter if it's 7 million or 47 million? Is minus 40 really that much colder than minus 20? It's a crisis no matter how you rearrange the numbers.

Just some of my left leaning socialist opinions . . .

 

[Dr. Dukes]

If one of these people gets in a car accident or gets cancer, society will pay one way or another. Just because someone made a stupid decision - does that mean we're not, as a society, going to care of him/her?

This is why we need to figure out how to have a mandate that everyone NEEDS to have health insurance. We don't let people drive without car insurance for the reason that if it was optional no one would get it and then people/society would be screwed when someone decided to flip their SUV doing 90 on the highway while wasted. Unfortunately, having a car isn't a right (like being healthy) so the states have an easy way to require car insurance (can't get a car without proof of insurance). I've had this conversation with a bunch of friends and no one can come up with a good way to require health insurance and penalize those who don't have it (cause we'd treat the uninsured anyway).

 

[Hard24Get]

This is why we need to figure out how to have a mandate that everyone NEEDS to have health insurance. We don't let people drive without car insurance for the reason that if it was optional no one would get it and then people/society would be screwed when someone decided to flip their SUV doing 90 on the highway while wasted. Unfortunately, having a car isn't a right (like being healthy) so the states have an easy way to require car insurance (can't get a car without proof of insurance). I've had this conversation with a bunch of friends and no one can come up with a good way to require health insurance and penalize those who don't have it (cause we'd treat the uninsured anyway).

That's what Clinton wants to do - mandate health insurance and fine people who don't have it. I happen to disagree, but there it is

 

[EM2BE]

How can the AMA back such a thing? I thought they had to have some type of consensus among the members to do these things. Maybe I'm just disillusioned.

 

[GeneralVeers]

Does it really matter if it's 7 million or 47 million? Is minus 40 really that much colder than minus 20? It's a crisis no matter how you rearrange the numbers.

Just some of my left leaning socialist opinions . . .

Actully minus 40 IS a lot colder than minus 20. I grew up in Calgary, so have some insight into that.

Once again your medial school idealism shows through.

My point is that the "47 million" has been portrayed in the media as all poor Americans who are being screwed over by the system. The data shows that for 3/4 of that number, it is not actually the case. The reason that this is important is that the AMA is using the 47 million number as a case to advocate for universal healthcare. My understanding is that the AMA is there to represent physician interests, and for them to embark on a media campaign without a consensus among physicians is irresponsible.

 

[futuredo32]

If it doesn't violate the TOS and if you had the time to post the whole editorial, I'd really like to read it.

 

[Miami_med]

I haven't seen the AMA effectively advocate for anything representing physician interests in a long time. They seem to have become enamored with buzz words and high school soda machines like the rest of the political machine, and all of the garbage that those involved in the actual practice of medicine have to put up with seems to not matter. I'm a little surprised that some other entity hasn't shown up to try and court physician money for the purpose of ACTUALLY protecting physicians politically.

 

[lucky_deadman]

Actully minus 40 IS a lot colder than minus 20. I grew up in Calgary, so have some insight into that.

Once again your medial school idealism shows through.

My point is that the "47 million" has been portrayed in the media as all poor Americans who are being screwed over by the system. The data shows that for 3/4 of that number, it is not actually the case. The reason that this is important is that the AMA is using the 47 million number as a case to advocate for universal healthcare. My understanding is that the AMA is there to represent physician interests, and for them to embark on a media campaign without a consensus among physicians is irresponsible.

Not getting into any war of words or pissing contest, but it was the physicians/medical students who pressed for this to be "the top priority" for the AMA. They do have a consensus amongst the physicians who are involved. It's not practical or even feasible to get a consensus among all physicians.

And they are not advocating for "universal healthcare" such as a single payer or socialistic/communistic run system but rather they want healthcare for all. They have varying plans but basically want the government help ensure everyone has coverage (especially those that need/want it).

 

[GeneralVeers]

Not getting into any war of words or pissing contest, but it was the physicians/medical students who pressed for this to be "the top priority" for the AMA. They do have a consensus amongst the physicians who are involved. It's not practical or even feasible to get a consensus among all physicians.

And they are not advocating for "universal healthcare" such as a single payer or socialistic/communistic run system but rather they want healthcare for all. They have varying plans but basically want the government help ensure everyone has coverage (especially those that need/want it).

The advertisements don't state exactly how the AMA wants everyone to be covered. The details are the important part of any plan, and can range from making people buy health insurance who can afford it, to a single-payer national system. The politicians and social advocacy groups will use the AMA to say that "doctors want universal health care". That is what I'm afraid of.

 

[lucky_deadman]

The advertisements don't state exactly how the AMA wants everyone to be covered. The details are the important part of any plan, and can range from making people buy health insurance who can afford it, to a single-payer national system. The politicians and social advocacy groups will use the AMA to say that "doctors want universal health care". That is what I'm afraid of.

This is very true. I do think that the clarification could and should be made.

 

[WallowaWanderer]

Once again your medial school idealism shows through.

Ouch, man. Just trying to be part of the discussion. I think everyone can speak on this subject because everyone's affected (even, like, non-medical people). And I wasn't sure what you meant by "once again"

 

[Hard24Get]

Once again your medial school idealism shows through.

Well, once again your bitterness shows through! Like Wallowa said, this issue affects all of us. Why can't we participate without being attacked? Just because we're lowly medical students we can't have an opinion? We will be residents in a few mos, hopefully we will not be as condescending as you are. 👎

 

[GeneralVeers]

Well, once again your bitterness shows through! Like Wallowa said, this issue affects all of us. Why can't we participate without being attacked? Just because we're lowly medical students we can't have an opinion? We will be residents in a few mos, hopefully we will not be as condescending as you are. 👎

It's not bitterness. I noticed the "let's save the whole world" attitude among my colleagues in med school. By the end of four years, most of them thought as I did after having interactions with patients and other health care providers.

I agree entirely with you that we we SHOULD have free health care to everyone in the world. Then the rational part of my brain that is used to dealing with the real world takes over, and I realize the impossibility of the task. Over and over again we hear about the 47 million, when in fact it's 8-9 million people who really need the assistance. I just like to try and keep the AMA, my colleagues, and the pundits honest. If that makes me cynical and bitter, then so be it.

 

[EctopicFetus]

1) the AMA sucks.

2) why should healthcare be treated any differently than any other service..

good night..

 

[da8s0859q]

Well, once again your bitterness shows through! Like Wallowa said, this issue affects all of us. Why can't we participate without being attacked? Just because we're lowly medical students we can't have an opinion? We will be residents in a few mos, hopefully we will not be as condescending as you are. 👎

Having briefly met/spoken with GV once upon a time in that weird place we call real life, I can say that he's most definitely not being condescending; he's a good guy. He's just calling it as he sees it.

I just happen to agree with him.

Signed,
even lowly-er premed minus the stereotypical idealism

 

[TraumaCheers]

Actully minus 40 IS a lot colder than minus 20. I grew up in Calgary, so have some insight into that.

Once again your medial school idealism shows through.

My point is that the "47 million" has been portrayed in the media as all poor Americans who are being screwed over by the system. The data shows that for 3/4 of that number, it is not actually the case. The reason that this is important is that the AMA is using the 47 million number as a case to advocate for universal healthcare. My understanding is that the AMA is there to represent physician interests, and for them to embark on a media campaign without a consensus among physicians is irresponsible.

.

 

[NSAIDAllergy]

How can the AMA back such a thing? I thought they had to have some type of consensus among the members to do these things. Maybe I'm just disillusioned.

Yet another reason to renounce membership.👎

 

[NSAIDAllergy]

Over and over again we hear about the 47 million, when in fact it's 8-9 million people who really need the assistance. I just like to try and keep the AMA, my colleagues, and the pundits honest. If that makes me cynical and bitter, then so be it.

Bravo, General.😎

 

[WallowaWanderer]

Just curious . . . Why does everyone hate the AMA?

 

[EM2BE]

I am not a member of the AMA (then again I am a DO).

I think this comparison I made with someone who was for socialized medicine was quite good: If everyone has a right to health care, then everyone should have the right to healthy foods and clean water. After that, who knows where it would extend. After that statement, the person didn't know where to go with the argument.

 

[tkim]

I am not a member of the AMA (then again I am a DO).

You can join as a DO.

 

[EM2BE]

You can join as a DO.

I am aware of this, but just haven't chosen to do so.

 

[Hard24Get]

It's not bitterness. I noticed the "let's save the whole world" attitude among my colleagues in med school. By the end of four years, most of them thought as I did after having interactions with patients and other health care providers.

I agree entirely with you that we we SHOULD have free health care to everyone in the world. Then the rational part of my brain that is used to dealing with the real world takes over, and I realize the impossibility of the task. Over and over again we hear about the 47 million, when in fact it's 8-9 million people who really need the assistance. I just like to try and keep the AMA, my colleagues, and the pundits honest. If that makes me cynical and bitter, then so be it.

I don't have a problem with your views, and haven't really expressed mine. All I'm saying is there are attendings, etc, that have the same views as Wallowa, etc, so when you disagree with him, you should point out why without engaging in the personal attacks. That is all.

Having briefly met/spoken with GV once upon a time in that weird place we call real life, I can say that he's most definitely not being condescending; he's a good guy. He's just calling it as he sees it.

I just happen to agree with him.

Signed,
even lowly-er premed minus the stereotypical idealism

again, I considered the personal attacks condescending, and was just calling it like I see it, too

 

[tkim]

I am aware of this, but just haven't chosen to do so.

Ah, you made it sound like being a DO restricted you from joining.

 

[WallowaWanderer]

I don't have a problem with your views, and haven't really expressed mine. All I'm saying is there are attendings, etc, that have the same views as Wallowa, etc, so when you disagree with him, you should point out why without engaging in the personal attacks. That is all.

Yeeiiah. That's right. H2 is sticking for me! It pays to have friends in high places. We M4's got to stick together.

H2 - I visited a certain program in southern California recently. Bet you can't guess which one? Wow, those are some pimped out trailers!

 

[NSAIDAllergy]

They have varying plans but basically want the government help ensure everyone has coverage.

This is not the government's job. It has never been the government's job. If we can withstand the damage to the country of the counter culture of the 1960s (You know, "the Establishment" that tells us to "fight the Establishment?), it never will be the government's job.

One other small point. "Free Healthcare" does not exist, nor can it. Either you purchase it from "evil" insurance corporations or you get your money taken from you by the government and they tell you what you will get for your money.

 

[WallowaWanderer]

This is not the government's job.

Not to get into a political battle . . . but it's the government's job in most developed countries. I respect your opinion, however.

 

[EctopicFetus]

Not to get into a political battle . . . but it's the government's job in most developed countries. I respect your opinion, however.

Different strokes for different folks. I dont want some low life scum sucking politician dictating my healthcare.

Perhaps we should worry about food, clothing, and shelter first but thats not as sexy. Oh and education, they sure do love to cut that cost.

 

[GeneralVeers]

Different strokes for different folks. I dont want some low life scum sucking politician dictating my healthcare.

Perhaps we should worry about food, clothing, and shelter first but thats not as sexy. Oh and education, they sure do love to cut that cost.

I find it interesting that they lump 10 million illegals in the "uninsured" category. I cannot believe that there are people who think that people who enter the country illegally, don't pay taxes, and break the law have a RIGHT to free health care paid for by our government. Once we take care of that other 40 million AMERICANS who don't have health insurance, then maybe if there's money left over we can give some to the illegals.

 

[EctopicFetus]

I find it interesting that they lump 10 million illegals in the "uninsured" category. I cannot believe that there are people who think that people who enter the country illegally, don't pay taxes, and break the law have a RIGHT to free health care paid for by our government. Once we take care of that other 40 million AMERICANS who don't have health insurance, then maybe if there's money left over we can give some to the illegals.

Agreed...but food clothing and shelter first.. then education.. then I will begin to worry about healthcare..

 

[Hard24Get]

Different strokes for different folks. I dont want some low life scum sucking politician dictating my healthcare.

Perhaps we should worry about food, clothing, and shelter first but thats not as sexy. Oh and education, they sure do love to cut that cost.

I agree with this - food, shelter, and education come first, why they do not baffle me.

I think the most important thing to do from the healthcare standpoint is to increase medicaid reimbursement so that the underinsured do not cripple academic and county hospitals. I also think the government should reimburse hospitals fairly for caring for the uninsured. Why should the hospitals bear the financial burden of EMTALA? These unfunded mandates are why so many hospitals are in trouble now. If that opinion makes me idealistic or naive, so be it.

 

[Hard24Get]

Yeeiiah. That's right. H2 is sticking for me! It pays to have friends in high places. We M4's got to stick together.

H2 - I visited a certain program in southern California recently. Bet you can't guess which one? Wow, those are some pimped out trailers!

PM me

 

[southerndoc]

Different strokes for different folks. I dont want some low life scum sucking politician dictating my healthcare.

Perhaps we should worry about food, clothing, and shelter first but thats not as sexy. Oh and education, they sure do love to cut that cost.

As opposed to some suited businessman or worse yet, somebody with a high school education who is told "deny at least 10% of claims?"

Nearly all developed nations have universal health insurance, a national health service, or some equivalent. Even China is moving to one.

 

[southerndoc]

I find it interesting that they lump 10 million illegals in the "uninsured" category. I cannot believe that there are people who think that people who enter the country illegally, don't pay taxes, and break the law have a RIGHT to free health care paid for by our government. Once we take care of that other 40 million AMERICANS who don't have health insurance, then maybe if there's money left over we can give some to the illegals.

If it's a sales tax, they would pay for their healthcare. Personally, I favor elimination of the income tax and moving solely to a sales tax or VAT.

 

[docB]

I agree with this - food, shelter, and education come first, why they do not baffle me.

I think the most important thing to do from the healthcare standpoint is to increase medicaid reimbursement so that the underinsured do not cripple academic and county hospitals. I also think the government should reimburse hospitals fairly for caring for the uninsured. Why should the hospitals bear the financial burden of EMTALA? These unfunded mandates are why so many hospitals are in trouble now. If that opinion makes me idealistic or naive, so be it.

People already get education for free. Food and shelter are tangible goods that would literally have to be confiscated from their owners and redistributed to who ever the govt. decided deserves them or bought with govt. funds resulting in higher taxes. That would be unpopular with whoever the goods were taken from or taxpayers and so would cost votes. Healthcare was provided via EMTALA as an unfunded mandate. No higher taxes, just higher healthcare costs, but the voters are not sophisticated enough to understand that they're still paying for it. That's why the unfunded mandate/EMTALA route is so popular with politicians. We (EPs) and hospitals don't like EMTALA but we really don't count in the political system.

Another thing we are up against is public ignorance about how everything dysfunctions. Do an experiment. Ask your non-medical friends and family who pays when the indigent or uninsured/no pays go to the ED. I have found that the vast majority of lay people think incorrectly that the government steps in and pays at least a portion of those bills.

 

[GeneralVeers]

Government has already demonstrated that it can't provide food/housing in a responsible manner. The food stamp program is a disaster, as people sell their food stamps for drugs, or buy inappropriate items at the store with them. To think it can run something like healthcare any more effectively is a fantasy.

The best method would be to give people a credit to buy limited insurance, i.e. insurance that would provide primary care, basic emergency care, and protect against catastrophic illness. The amount of care could be pro-rated based on risk factors, i.e. people who smoke or decide to be fat get less insurance or have to pay for supplementary coverage. On some level, people are responsible for their own health and their health costs.

I can't believe how many "disabled" people who don't work and get government assistance due to obesity come to the ED. These people literally beach themselves in an ED bed and say "take care of all of my problems for me".

 

[waldenwoods]

I have seen some of the ads and I guess for some people it could push some buttons with respect to how they feel the AMA is portraying the opinions of its members (or perhaps some think it represents all physicians, whether members or not?). Unlike the AMA, the KFF does not lobby politicians; instead, it has established itself as a credible authority on health policy issues. Regardless of the media campaign, uninsured as well as underinsured people create a problem for our health system, and there the publications put out by the Kaiser Family Foundation if you're looking for more objective information.

I'm not saying you have to read the entire document, but the KFF's primer about the uninsured (http://www.kff.org/uninsured/upload/7451-03.pdf) is a good resource.

One quote from the document that I think captures the essence of the problem that the AMA is highlighting in its campaign is: "The majority of uninsured adults (75%) have gone for coverage for a period of at least one year." So the entire 46.5 or 47 million (depending on whose data) maybe aren't in such dire need of health insurance (barring the onset of an acute condition). But then the majority of the uninsured probably have some health care issue that isn't being taken care of in a timely manner because those people have gone without insurance for a significant period of time.

 

[WallowaWanderer]

Wow, check out this title under "similar threads" that crops up at the bottom for the page:

"Compassionate Conservative" Attempts To Murder Democrat At Campaign Rally For Satan.

What an awesome headline.

 

[EM2BE]

Ah, you made it sound like being a DO restricted you from joining.

Understandable after re-reading my post.

A question for you all: Has the government ever been able to run anything efficiently?

 

[pseudoknot]

Understandable after re-reading my post.

A question for you all: Has the government ever been able to run anything efficiently?

The Canadian healthcare system has far lower administrative costs than ours, as does the VA if I remember correctly.

The fire service seems better off as a government function than private, as another example.

 

[NSAIDAllergy]

Not to get into a political battle . . . but it's the government's job in most developed countries.

and?

 

[Tiger26]

scary ad-->real universal healthcare undertones

 

[polygonal]

The Canadian healthcare system has far lower administrative costs than ours, as does the VA if I remember correctly.

The fire service seems better off as a government function than private, as another example.

Canada?!!?! The VA?!?!? HAHAHAHAHA

Have you ever seen healthcare in Canada firsthand? Have you ever been in a VA? I have to stop laughing long enough to finish typing this.

Sorry, I just can't do it. Be back later.

 

[EctopicFetus]

As opposed to some suited businessman or worse yet, somebody with a high school education who is told "deny at least 10% of claims?"

Nearly all developed nations have universal health insurance, a national health service, or some equivalent. Even China is moving to one.

One of many reasons I live here and not there.

 

[GeneralVeers]

The Canadian healthcare system has far lower administrative costs than ours, as does the VA if I remember correctly.

The fire service seems better off as a government function than private, as another example.

I grew up in Canada and experienced their care first hand.

I keep trying to educate people about this. Yes, everyone gets free health care in Canada. The care they get is markedly inferior in terms of access, time to treatment, and quality of care. Unless you live in downtown Toronto, your care will be inferior to that received in the U.S.

You get nothing for free. If you want government provided care, you will pay for it both in higher taxes, and longer waiting times. I doubt that 90% of the population would be willing to see their level of care suffer so that the 10% can benefit.

 

[WallowaWanderer]

I keep trying to educate people about this. Yes, everyone gets free health care in Canada. The care they get is markedly inferior in terms of access, time to treatment, and quality of care.

That's the trade off with universal health care - it's care for everyone but it's low level care. Everyone gets something. That would be difficult for American's to swallow, because so many of the middle class think they have a right to the best of the best in medical care (my back hurts - I need my MRI now!). It's the "everyone gets a chevy" model versus the "some get cadillacs and the rest can walk" model. The beauty is that those who want more more and happen to be wealthy can buy it on the private market.

A few people have brought up the "nothing is free" idea. Come on, do you think people who believe in universal health care are so stupid as to think they could just create it for free? I know it would be a burden and mean more taxation, but I believe it's worth it because I think that society has an interest in keeping people healthy. The healthier people are, the less health care costs. As a society we can choose to either pay for someone to have their blood pressure and glucose checked at their PCP or pay for them to be on dialysis because they never could get to a PCP. If the uninsured/under-insured/partly-insured had better access to primary care, their care would be much less expensive. What we have now is a system where many don't get primary care, their chronic medical condition starts to kill them, and then they end up needing really expensive care.

Again - socialist (almost communist), idealist, MS4

 

[GeneralVeers]

Again - socialist (almost communist), idealist, MS4

That's your opinion. I'd rather have autonomy over my own care, and not expect the government to look after me.

BTW in Canada the rich cannot buy better care without leaving the country. It's been illegal since they enacted Medicare to provide private for-profit care. This is slowly changing as they are getting more and more private clinics, but it's still not acceptable.

 

[Dr. Dukes]

That's what Clinton wants to do - mandate health insurance and fine people who don't have it. I happen to disagree, but there it is

I don't actually like it much either, but short of regulating the insurance industry and breaking up the companies (the county where my school is went from 15-3 unique insurance companies in the last decade), I don't know what else to do.

 

[paramed2premed]

I don't actually like it much either, but short of regulating the insurance industry and breaking up the companies (the county where my school is went from 15-3 unique insurance companies in the last decade), I don't know what else to do.

You know, this is not a partisan issue, despite the attempt to drop the "H-bomb" into the discussion.

This may be Clinton's plan, but it is what Romney has already done as governor of MA.

You know he's a big tax & spend liberal!