Thursday, December 1, 2016

#notmyAMA again: Dr. Tom Price, greedy tosser

If a general internist like myself were asked why I never pay up on those "dues payments" envelopes the American Medical Association is always sending to my house (Dear doctors: I have never in my life belonged to the AMA, and I don't owe any freakin dues!), I might say, off-handedly: 

"I mean, some large part of the AMA is like, a bunch of cranky old orthopedic surgeons crying about how they hate Medicare."

Prior to recent events, I could generally admit that is probably a primary-care-righteous parody of a more complex reality. (I mean, JAMA is a pretty decent journal, right?) But now like so much in politics these days, the AMA has just responded with an endorsement: "Yes! We will take your simplistic caricature of us and double down on it! Dr. Tom Price is exactly your exaggerated parody of our point of view and we super-duper endorse him!" 

And yeah, I know a lot of the professional organizations are sending congratulatory messages because a) it could've been worse and b) they want to kiss the ring of the man who will hold the money bags; and on that level it's not about ideology. It's just business.

And that's the problems. I mean, let's leave aside the fact that guys like Tom Price do blustery conservative things like hate gay people and want to ban abortion and on and on. I mean, that stuff is awful and a sign of lots of bad things to come, but it may not be how Tom Price will actually harm the most people.  

The reason he might be most dangerous is why the AMA is actually excited about him: they describe him as "a leader in the development of health policies to advance patient choice and market-based solutions". That means, quietly but surely dismantling Medicare and Medicaid. Among other things, one of his pet causes is allowing doctors to charge fees above Medicare reimbursements. For people who do one-time procedures, like orthopedic surgeons, they can collect relatively nominal fees relative to their income, and still filter out the impoverished and disabled. And if they collect larger fees, even fees accessible to middle-class people, then, they can make some more serious cash money. (Charging, say, an extra $500 bucks per procedure, when a full time orthopedic surgeon does ~30 procedures a month, is going to be within most people's reach given the stakes of having a surgeon you trust--who in turn would earn a decent chunk of change.)

You can also predict an incoherent emphasis on "responsibility" and "empowerment" and "choice" in opaque policies that hurt the most impoverished and benefit insurers and doctors and hospitals. If you look at Indiana's Medicaid expansion--where poor people are penalized for not paying small premiums, costs don't decrease, and doctors get paid more--you might get a sense of how this is going to go just based on regulatory choices, without even having to pass legislation. (Look here at the difference between HIP Plus and HIP Basic; or here and here.) Of note: the architect of Indiana's Medicaid expansion is now going to be the director of the Centers for Medicare and Medicaid Services. 

The good news is that Republican congresspeople are already starting to back away from Medicare privatization like it's radioactive poop in the pool. The bad news? They won't have any such hesitation on Medicaid block grants and other punish-the-poor tactics.


Mu-receptor mixtape track of the day: a throwback 2011 health policy rap from the UK, taking a stand against conservative plans for the National Health Service:






(edited slightly Dec 10)










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