AMA, CMS Chief Strongly Oppose Single Payer System

Marcia Frellick

June 12, 2019

CHICAGO — The American Medical Association (AMA) reinforced its longstanding opposition to a single-payer health system on Tuesday by rejecting a proposal to study single-payer plans.

Instead, the AMA voted to approve a plan to strengthen insurance provisions of the Affordable Care Act (ACA).

"The AMA proposal supports health system reform alternatives that ensure pluralism, freedom of choice, freedom of practice, and universal access for patients," AMA President Barbara McAneny, MD, said during her reference committee testimony on Sunday.

"I would like to remind this house of the yearly ritual under the SGR [sustainable growth rate] of wondering whether we would receive the threatened 20% cuts. Why would we want to expand that to all of healthcare? May I also remind the delegates that we have fought very hard against insurance mergers because of the problems of having one large insurance company," she explained.

"While some may be disappointed that the council did not recommend removing AMA's opposition to single-payer proposals, be assured that the AMA will be at the table for health reform proposals introduced and debated," McAneny added.

The policy recommendations, adopted by the House of Delegates here at the AMA 2019 Annual Meeting, include removing the "subsidy cliff" and expanding eligibility for premium tax credits to those above 400% of the federal poverty level; increasing the size of cost-sharing reductions for those who qualify for them, and extending eligibility for cost-sharing reductions beyond 250% of the poverty level.

The AMA vote came after a weekend protest by supporters of Medicare for All plans.

Protests

On Saturday, a group of doctors, nurses, and medical students protested outside the meeting and a smaller group disrupted discussion inside.

In an editorial in the Guardian that announced the group's planned protest, organizers of the rally explain that medical students and professionals "have had enough."

"The AMA uses the prestige of its white-coated members to push for market-based health reforms that maintain the status quo of our fractured health system: one in which some Americans have a lot, others have a little, and some are left with absolutely nothing," they write.

Medicare for All has gained notoriety as nearly half the Democratic presidential candidates support some version of it.

Results from a recent Medscape poll showed that physicians, nurses and advanced practice registered nurses, pharmacists, and other healthcare providers are fairly evenly divided on whether to support Medicare for All.

CMS Chief Warns Medicare for All Would Hurt Healthcare

"I am deeply concerned about proposals for Medicare for All," Seema Verma, administrator for the Centers for Medicare and Medicaid Services, told delegates on Monday, to wide applause.

"Medicare for All would strip private health insurance from 180 million people, take away choices, and force them into a one-size-fits-all government program," she explained. And the impact on Medicare for All on physicians would be particularly detrimental.

"Analyses of Medicare for All indicate that it would lead to lower physician reimbursement, some showing reductions on the order of 40%. This could lead to major access problems for all Americans, as some doctors may choose not to participate," Verma added.

Some who testified, however, said the AMA has cut off a vital path of discussion.

"As physicians, we pride ourselves on being scientists and following evidence-based data in decision-making. Work in the field of behavioral economics tells us that the way humans make decisions is highly influenced by how the options are presented to us," Abby Solom, a medical student testifying on behalf of the Minnesota Medical Association, said on Tuesday.

"If we frame the discussion about healthcare financing options firmly anchored to a position of opposition to one of those options, there is no way we can consider all options fairly. It's disingenuous to believe otherwise. And if we believe we can overcome these decision-making heuristics because we are less biased than others, we are simply wrong," she said.

McAneny, Verma, and Solom declared no relevant financial relationships.

American Medical Association (AMA) 2019 Annual Meeting. Presented June 9, 10, 11, 2019.

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