CHICAGO – If President Barack Obama wants to win U.S. doctors’ support for his plans to expand medical coverage to more than 46 million uninsured Americans, he may need to hike physicians’ pay from Medicare and install liability reform.

Obama on Monday will address the American Medical Association at the Hyatt Regency Chicago. On Saturday, the group’s president, Dr. Nancy Nielsen, sounded an aggressive call for changes that doctors say are long overdue.

“Let’s fight this battle to completion,” Nielsen said. “No more short term fixes. No more waiting. No more promises.”

Among the AMA’s key wants, Nielsen told the group’s 543-member policy-making House of Delegates, are increased payments from Medicare and medical liability reform that caps non-economic damages and allows doctors to abide by the coming trend of quality measures that pay physicians based on performance without being penalized for mistakes.

Obama previously has called on doctors, hospitals and other medical care providers to curb costs by reining in of unnecessary tests and procedures with an intense focus on quality.

“If doctors have incentives to provide the best care instead of more care, we can help Americans avoid costly hospital stays, treatments and tests that drive up costs,” Obama said Saturday in his weekly address. “These savings underscore the fact that securing quality affordable health care for the American people is tied directly to insisting upon fiscal responsibility.”

Though the AMA has lost some of its clout in recent years, the Chicago-based national group is still the largest physician lobby, representing a quarter of a million doctors.

The House of Delegates that Obama will address has an even broader reach, representing 180 state and national medical societies that include everything from family doctors and psychiatrists to cardiologists and neurosurgeons.

“Obviously, doctors are on the front lines of almost every medical decision,” White House press secretary Robert Gibbs said Friday. Obama’s address to the AMA will “touch on many topics that are important to them … about who medicine is delivered, how that efficiency can be improved,” Gibbs said.

Doctors felt they were excluded from the Clinton administration’s health care reform push in the early 1990s and physician opposition, along with an ad blitz by insurers, helped doom that initiative.

The AMA has already said it worries about certain aspects of a government-funded form of health insurance such as an expansion of Medicare to more than just the disabled and those 65 and older.

Doctors have been battling for years to restore cuts in payments from a Medicare system. Therefore, they are vehemently opposed to expanding what they call a broken system.

“The whole Medicare funding formula is fundamentally flawed and needs to be fixed,” said Dr. James Milam, president of the Illinois State Medical Society.

Obama has said repeatedly that he supports a public option that would bring more competition to the private insurance market. What is unclear, however, is exactly what that public option would look like.


While doctors often complain about the checks and restrictions that private health insurance companies place on the way they do business, the AMA and many of its members see private health plans as the most innovative.

Increasingly, private insurers are paying doctors bonuses if they adhere to certain quality measures such as making sure patients get routine medical care or adhere to treatments.

Still, there are doctors who favor a single payer, government-run approach.

“The only real solution is a single payer governmentally controlled insurance program that removes this unnecessary overhead in the current system,” said Dr. Peter Orris, chief of occupational and environmental medicine at the University of Illinois at Chicago Medical Center and a member of Physicians for a National Health Program.



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AP-NY-06-13-09 2144EDT


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