The AMA is the biggest physician lobby in the country and has been a player both in shaping the health reform bill and pushing Congress to pass your pay fix. I managed to catch up with the AMA's incoming president, Cecil B. Wilson, as the good doctor (he's a longtime internist) was waiting in an Atlanta airport for a flight to Chicago. He was very generous with his time and offered some rather candid commentary -- in my opinion -- on the state of the pay fix.
Here's a full transcript of our conversation, which covered the temporary and permanent pay fixes, the role of the AMA during the crafting of the health reform bill, and the controversy over whether the AMA had a secret deal with the White House to support reform in return for a guaranteed permanent fix.
Q. What are your thoughts on the current Medicare pay-fix situation?
A. We're continuing to call on Congress to do a permanent fix. They've put this off long enough. It used to be put off once every year and now it's every month. The Medicare program has just become too unreliable ... for doctors. Physicians are just incensed that Congress hasn't done this, and I think patients and seniors will be jumping up and down.
Q. What is the AMA's plan going forward to address the pay fix?
A. We are working with the administration and Congress to find a vehicle to make sure doctors will be paid. The reality is, if the cut goes through, this program is going to fall apart because physicians are going to walk out in droves. If the cut does not go through [but there's no permanent fix] we're not sure what's going to happen. We know from polls that two-thirds of doctors are going to stop taking new Medicare patients, or will take less. We can also anticipate that as physicians continue to assess their future, about how much they're going to be paid, about buying new equipment, about changing to an [electronic health record or EHR], they can't do that when a significant part of their payments are gone or always in question. All of these things are happening as a result of these constant cuts and patches.
Q. What is the AMA's response to the criticism that a permanent fix to the sustainable growth rate (SGR) formula is too costly given the size of the federal deficit, the state of the economy and the shortage of ways to pay for it in a budget-neutral way?
A. People who point out there's this sensitivity [to costs] now are exactly right. Suddenly a lot of people in Washington have gotten religious about the debt. But the reality is the $240 billion [estimated cost of a permanent SGR fix] has been spent. All they need to do is declare that it is part of the [federal] debt.
Q. Do you think the issue of a permanent SGR fix is wholly separate from health reform, which is what Democrats say, but Republicans say the opposite, that the two should've been lumped together, which would've raised the price of reform over $1 trillion?
A. Clearly Democrats are very concerned about budget deficits, which is why they separated all this out. But they're not alone in that, the Republicans have said they're not going to vote for anything that increases the deficit as well. So I think the sensitivity is on both sides of the aisle. And I think the Republicans have an agenda as well, which is to oppose whatever this administration is suggesting.
Q. You've said in the past that the AMA received public assurances from Democratic leaders in the Senate, and even from the White House, that a permanent pay fix would be addressed in 2010. What happened to these public assurances?
A. You're referring to statements made during 2009 ... that reassurance was not lived up to. Congress did not live up to their responsibility. And you know what, it was more than a commitment to the AMA or even physicians in general. It was a commitment to seniors, baby boomers and members of our military.
Q. I've interviewed Republican members of Congress and lobbyists who say the AMA worked out a secret deal with the White House, where you would endorse the health reform bill in return for a permanent SGR fix. Is that true?
A. No, there's no truth to that. From the standpoint of the AMA, there have been no deals, there have been no quid-pro-quos, there have been no "if you do this I'll do that."
Q. What was the AMA's role exactly?
A. Well, let me just address that, what we did during the process of [Congress and the White House] putting together the health care reform bill. At each step along the way, what we have said is "this has good things in it and we think it should go forward, but there are other things that need to go in." But giving this feedback in no way obligated us to support the final health system reform package. One of the biggest decisions we made in my time on the [AMA Board of Trustees] was to say ... "on balance this bill has enough good things in it that we will support it, but none of this was conditional on anyone telling us that ‘if you do this, we'll do that.'"
Q. Why do so many people seem to believe there was an agreement worked out between the AMA and the administration, behind closed doors?
A. It's easy for people not sitting in the room to say "oh, well there must have been a deal." But I was in the room, I was intimately involved and I can tell you there was no deal. I will say this, almost every major [physician] initiative that's part of health reform, that is EHR [adoption], expanding [health information technology or HIT], comparative effectiveness research, medical homes, new payment systems, everything is dependent on a stable Medicare program. And as long as we don't have a permanent fix, we don't have that stability.