Every sign points to the conclusion that the American health care system in general and the economic underpinnings that support it in particular face a far greater peril in the years immediately ahead than at any time since then-President William J. Clinton proposed his Health Security Plan for universal insurance more than a decade ago. Consider the following facts:

1. Polls consistently indicate that voters rank “affordability of health care” second only to the economy as a major concern.¹

2. There are 43 million Americans, 15 percent of our population, who lack basic health care coverage while 60 million lack health coverage for a portion of the year.

3. The United States already spends more than any other country on health care, an estimated $5,440 per person annually.²

4. Health care expenditures increased 9.3 percent in 2002 while the gross domestic product (GDP) increased only 3.6 percent. Employers face rising heath insurance premiums while employees face increased cost-sharing.²

5. Health care spending now accounts for 14.9 percent of the GDP, making health care the largest U.S. industrial sector.²

6. The cost of the recently enacted Medicare drug benefit law grew from an estimated $400 billion over 10 years in November 2003 to $530 billion over 10 years by January 2004.³

7. The Institute of Medicine has recommended that both Congress and the White House begin working immediately toward universal health coverage by 2010.¹

8. In round numbers, the total additional federal budget outlay for universal health coverage in 2002 would have been somewhere between $90 billion and $100 billion.⁴

9. Health workforce expert Ed Salsberg predicts a shortage of 85,000 physicians by 2020, prompting the Council on Graduate Medical Education (COGME) to cast aside its forecast of a physician surplus, a position it had held since the mid-1980s.⁵

10. Managed care has been a failure.

It seems inescapable that concern about the uninsured, the rising costs for employers and employees alike and the increasing problems with access to care due to a shortage of physicians and nurses and overtaxed facilities will lead some policymakers to turn to a single-payer system similar to that first proposed by President Harry S. Truman more than five decades ago.

As the American Medical Association (AMA) prepares to address the threat of a single-payer health care system whenever it arises — a threat that must be defeated — it continues its ongoing efforts to address other issues of importance, including:

1. Medicare reform. Reduction of regulatory intrusions into physician practices resulted in the inclusion of important regulatory relief provisions in the recently enacted Medicare reform legislation.

2. Medical liability reform. Thanks to persistent efforts by AMA and its specialty society allies, the U.S. House of Representatives passed physician-backed, comprehensive medical liability reform in March 2003. While corresponding efforts in the Senate were not successful, reform received more votes than ever before, and Senate Majority Leader Bill Frist, M.D., (R-TN) has promised that the Senate will again consider the issue in 2004. President Bush urged reform in his State of the Union address.

3. Adequate physician reimbursement by Medicare. Obtaining adequate physician reimbursement in the Medicare program is arguably a more important issue than liability reform. AMA scored a remarkable victory for all physicians when the Medicare reform legislation replaced a 4.5-percent Medicare payment cut scheduled for January 1, 2004, with a 1.5-percent increase and the assumed 1.7-percent cut scheduled for January 1, 2005, with another 1.5-percent increase. The average increase per physician for all states in 2004-05 is $16,000, and this figure does not include potential “spillover” effects from Medicaid and other plans that tie payments to Medicare rates.

While the new Medicare rates for 2004-05 were a welcome victory for physicians, the flawed sustainable growth rate (SGR) formula must be replaced by 2006 or medicine will face the “cliff,” when now-delayed payment reductions probably totaling 7 percent to 10 percent will automatically be imposed.

Daunting challenges await medicine, but I believe that AMA’s Washington staff (numbering about 21 people, including 10 lobbyists and seven health care attorneys), working in a collaborative manner with specialty society advocates such as ASA Director of Governmental and Legal Affairs Michael Scott and Assistant Director of Governmental and Legal Affairs (Federal) Manual Bonilla are equal to the task.

ASA Past President John S. Hattox, M.D., in a presidential address to our House of Delegates, stated that “the AMA is the only train on the track in Washington.” His words are as true today as they were in 1980; if anything, AMA is probably more effective today than ever because it has honed its ability to develop collaborative and coordinated campaigns with various specialties so that American medicine speaks with one voice.

As successful as AMA has been in speaking for American medicine in general and our specialty in particular, one can only speculate about “what might have been” if AMA represented a more robust percentage of physicians. Currently AMA has a 26-percent market share among physicians and medical students; 8,800 ASA active members also are AMA members, representing about 35 percent of ASA members. We do need to do more, and we can do more.

If you appreciate a $16,000 increase in Medicare reimbursement, and if you care about implementation of a reasonable Medicare reimbursement formula, tort reform at the federal level, reduction in bureaucratic intrusions and defeat of a single-payer system, put down your NEWSLETTER, pick up your checkbook and join AMA.

The stakes are too high and the dangers too real for any of us to be on the sideline as decisions are made about the future of American medicine. Give us the resources required for victory — an increase in ASA members who also are AMA members.

References:

1. Finkelstein JB. Health insurance access is back on America’s agenda. Am Med News. 2004; 47(5):1-2.

2. Appleby J. Health care spending’s rapid growth “threatens affordability”; enrollment in health plans falls for 2nd year: [Final Edition] USA Today. McLean, Va.: January 9, 2004; section B, page 2.

3. Pear R. Bush’s aides put higher price tag on MEDICARE law [Late Edition: Final] New York Times. January 30, 2004; section A, page 1.

4. Reinhardt U. The promises and the reality. A benchmark shows real cost and effect of candidate’s plans for the uninsured. Mod Health. 2004; 34(4):28.

5. Vogt K. Tax planning never stops. Am Med News. 2004; 47(3):12-13.

John B. Neeld, Jr., M.D., is Chair of Anesthesiology, Northside Hospital, Atlanta, Georgia. He was ASA President in 1999.