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CHICAGO -- The American Medical Association (AMA) House of Delegates on Tuesday reiterated its longstanding opposition to single-payer healthcare systems, including "Medicare for All," despite warnings that the AMA risks being left out of crucial healthcare reform discussions.
On Tuesday, delegates voted down a proposal to shift the AMA's official stance on single-payer insurance to neutrality.
"We proposed this amendment because we are concerned about the AMA's ability to be invited to all healthcare reform conversations," Daniel Pfeifle, of Sioux Falls, South Dakota, said on behalf of the Medical Student Section. "As long as we maintain our blanket opposition, our AMA cannot ensure we're part of every conversation."
"The way humans make decisions is highly influenced by how the options are presented to us," said Abby Solom of Plymouth, Minnesota, speaking for that state's delegation. "If we frame the discussion about healthcare delivery options firmly anchored to a position of opposition to one of those options, there is no way we can consider all of the options fairly. It's disingenuous to believe otherwise. ... We should support the medical students' amendment and study how to best provide healthcare for the people of this country based on AMA principles and without pre-defined conclusions."
Opponents of the proposal disagreed with the idea that the AMA would be left out of the discussion. "This is our American Medical Association; we're comfortable that what's best for patients is also best for the physicians who take care of those patients," said former AMA president Daniel Johnson, MD. "The question we have to ask is, 'What is best for [the] patients?'"
Johnson noted that the AMA will still continue to have a seat at the table "because we are the American Medical Association ... We're not conceding anything when we say that we want to continue to be opposed to the solution of single-payer."
"I think we ought to put a stake in the heart of single-payer," said former AMA president Donald Palmisano, MD, JD. "We've done it before -- we ought to do it again."
The discussion came in regard to a report on the issue of covering the uninsured from the AMA's Council on Medical Service (CMS), which recommended that the association support efforts included to improve the Affordable Care Act (ACA) and also continue its opposition to single-payer healthcare reform. "The council underscores that the AMA will continue to thoughtfully engage in discussions of health reform proposals, which will vary greatly in their structure and scope," the report said. "Opposing single-payer proposals does not preclude that engagement, nor mean that the AMA will not evaluate health reform proposals that are introduced. Ultimately, our AMA, guided by policy, will continue forward in its efforts to advocate for coverage of the uninsured."
In response, the Medical Student Section offered a proposal recommending that the AMA "revise existing policy to remove opposition to single-payer systems while preserving support for pluralism, freedom of choice, freedom of practice, and universal access for patients."
"We need to get involved at the start -- we can't just be at the final table," said Joy Lee, a medical student from Washington, D.C., who was speaking for herself. "When we have categorical opposition in our policy we can't be there from the very beginning. ... We are not asking for AMA to support single payer; what we are asking for is for the AMA to be involved in every proposal that comes out so we can shape final policy."
But before that proposal could be voted on, Jeff White, MD, of Shreveport, Louisiana, who was speaking for himself, offered an opposing amendment, which said the AMA should "recognize that adoption of a single-payor [sic] system, while perhaps providing universal access for patients, is inconsistent with true pluralism, freedom of choice, and freedom of practice." That amendment was voted down 122-430. The delegates then narrowly voted down the original amendment from the medical students by a vote of 254-292.
Medicare for All was constantly in the air during the first few days of the House of Delegates meeting. On Saturday, Medicare for All advocates -- including physicians -- rallied outside the meeting hotel and also disrupted the meeting proceedings going on inside, staging a "die-in" on the meeting room floor and unfurling a Medicare for All banner.
On Sunday, outgoing AMA president Barbara McAneny, MD, appeared at a reference committee meeting to discuss the CMS report. "The AMA proposal for reform supports health system reform alternatives that ensure pluralism, freedom of choice, freedom of practice, and universal access for patients," she said. "While the ACA has made significant progress, more needs to be done in covering the remaining uninsured ... The [report] recommendations support individually owned health insurance with tax credits inversely related to income ... [It] has potential to cover millions more Americans."
McAneny reminded the audience that under a previous Medicare reimbursement formula known as the "sustainable growth rate," doctors would be left each year "wondering if we receive the threatened 20% cuts. Why would we want to expand that to all of healthcare?" she added. "While some may be disappointed that the council did not recommend removing the AMA's opposition to single-payer proposals, be assured the AMA will be at the table when health reform proposals are introduced and debated."
On Monday, Seema Verma, administrator of the Centers for Medicare & Medicaid Services, told the AMA delegates that "the impact of Medicare for All on physicians would be particularly detrimental. Now, I know that our system isn't perfect, but it does afford you some ability to choose which payers you want to do business with, and what payment terms you're willing to accept. Medicare for All would take away that choice."
In other news from Tuesday's meeting session, the delegates elected Lisa Egbert, MD, an ob/gyn from Dayton, Ohio, as the association's next vice speaker; Bruce Scott, MD, an otolarygologist from Louisville, Ky., who served as vice speaker this past year, was approved as the new speaker earlier in the meeting.