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Advice to the AMA & AAMC as Trump Becomes Unhinged.

Posted on | May 11, 2017 | 5 Comments

Source: IrregularTimes.com

Mike Magee

These are troubled times for our nation. We are testing our democratic institutions, as well as the quality of our leaders. Will they stand up to a President who is unhinged and his sycophants who seek only a measure of power? With control of 1/5 of our economy, 1 in every 8 workers, and the health and welfare of 324 million Americans, health care leaders’ role is assured. But as we’ve seen with Tom Price, the possession of an M.D. does not assure wisdom, empathy, compassion, or understanding.

As I’ve said in the past, it is not easy to be the head of government relations for the AMA and the AAMC these days. Under the best conditions, the job requires unerring focus on priorities (like physician payment or funding for medical education and research), nimble short term planning, and above all covering your bases.

Their most recent calculation, to support one of their own – the ethically compromised Emory orthopedist Tom Price for HHS Secretary, who is also a card carrying member of the Association of American Physicians and Surgeons, is already in the wringer thanks to the Republican House’s push for Trumpcare. Likely both organization’s lobbyists anticipated as much, and were prepared to join a broad coalition including AARP, AHA, ANA and others “in defense of Medicaid expansion and vulnerable populations.”

The laughable contradiction of their full throated endorsement of Price, a champion of such restrictions, and their equally public opposition to legislation that originated from his lips, was executed with glib superiority. After all, at its core, government relations is an exercise in value-free pragmatics. Today’s friend is often tomorrow’s enemy. And these organizations have been fighting the good fight to protect their financial interests for many decades.

In addition to protecting their members’ interests – financial and otherwise – they must also protect corporate assets which are somewhat removed, and at times in conflict with patient care. Combined, the programs and services offered in 2014 by the two earned $475 million in revenue. Almost half of the revenue generated by the AMA came from royalties and sales associated with their exclusive control of the nation’s CPT codes and the Physician Masterfile Database that fuels physician prescription profiling. Just under 2/3 of the AAMC revenue derived from three data driven and monopolistic product sales – ERAS (Electronic Residency Application Service – The Match: $69.2M), MCAT (Medical College Admission Test: $33.2M), and AMCAS (American Medical College Application Service: $30.4M).

At times, member interests and corporate interests lack perfect alignment. For example, in late October, 2001, I was introduced to Senate Minority Leader Trent Lott (R-MS) as part of my campaign for Surgeon General. My handler, in his introduction, mentioned that I had been recommended for the job by AMA President Richard Corlin. Lott instantaneously erupted in anger and spewed the words, “You can have the AMA. I want nothing to do with them!” This confused me since I had assumed that the AMA was in good standing with President Bush and his Republican allies.

I was unaware at the time that Lott, a member of the Senate Finance Committee,  was in a pitched battle with the AMA over its exclusive ownership of CPT codes that are required for billing of physician services. His beef was twofold: 1) This “monopoly” as he called it required insurers and others to purchase CPT code books and pay royalties to the AMA which he claimed earned the AMA $71 million in 2001 (the AMA counter-claimed it was $18 million for what they defined as the “gold standard” of coding). 2) Lott felt the AMA’s control of the CPT codes and Physician Masterfile  Database was preventing the development of open source consumer health cost databases that would allow patients to compare costs of doctors and hospitals. This was part of a larger effort to address soaring Medicare and Medicaid costs.

At the time, one of Lotts countervailing medical association supporters was the Association of American Physicians and Surgeons, Tom Price’s current values home base. They weighed in at the time with this comment, “Senator Lott deserves everyone’s support in his effort to pull the rug out from under the AMA’s secret monopoly on these codes. Elimination of this AMA cartel will do more to protect patients than any patient’s bill of rights law.”

Times and circumstances change – sometimes suddenly, as we’ve seen this week. Our President is now unhinged and erratic. Our Secretary of HHS is more than a little ethically compromised and deeply connected to former AMA enemies. Our logical movement toward universality, simplicity, and continuity in health delivery is a step away from a reversal that would harm our economy and at least 24 million of our most vulnerable citizens.

So it’s not easy heading up government relations at the AMA or AAMC. There are a wide range of countervailing interests and priorities. In such complex times, it’s best to keep the advice simple. So here it is:

1. Support the good guys.

2. Protect those who can’t protect themselves – our most vulnerable.

3. Do the right thing – not for tomorrow, but for our future.

Comments

5 Responses to “Advice to the AMA & AAMC as Trump Becomes Unhinged.”

  1. Susan Pellerin
    May 11th, 2017 @ 8:10 pm

    Apparently some of them have forgotten the oath they agreed to: First do no harm!

  2. Janice Mancuso
    May 13th, 2017 @ 2:58 pm

    Leaders in all professions, especially Medicine, must continue to speak truth to power until it is heard far and wide by the majority of our citizens…so they in turn will be heard. If Timothy Egan of the NY Times was correct when he wrote the following in March (“A Great New Accidental Renaissance”), I’m hopeful:

    “It’s early, but we may be experiencing a great awakening for the humane values that are under siege by a dark-side presidency. People are going inward, to find something bigger than Trump, and outward, to limit the damage he inflicts on the country.”

    Keep up the great work & great writing. Thank you.

  3. Mike Magee
    May 13th, 2017 @ 3:15 pm

    Thanks, Janice!

  4. Susan Boggia
    May 13th, 2017 @ 6:58 pm

    Great article, Mike.

  5. Mike Magee
    May 14th, 2017 @ 5:54 pm

    Thanks, Susan!

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