James L. Madara, MD, CEO of the American Medical Association (AMA), began his letter to the United States Senate poetically:
“Medicine has long operated under the precept of Primum non nocere, or ‘first, do no harm.’ The draft legislation violates that standard on many levels.”
The letter concludes more concretely:
“We believe that Congress should be working to increase the number of Americans with access to quality, affordable health insurance instead of pursuing policies that have the opposite effect…”
Much of the debate over the ‘Trumpcare bill,’ also known as the American Health Care Act (AHCA), has come down to money: Republicans want the new bill to remove a tax on high-income individuals, and to raise prices of premiums and deductibles such that the Congressional Budget Office estimates would make 15 million more people uninsured next year compared with current law.
And Dr. Madara is worried about money as well, particularly per-capita-caps that would cut Federal Medicaid payments to states by 26% by 2026 :
“Per-capita-caps fail to take into account unanticipated costs of new medical innovations or the fiscal impact of public health epidemics, such as the crisis of opioid abuse currently ravaging our nation. The Senate proposal to artificially limit the growth of Medicaid expenditures below even the rate of medical inflation threatens to limit states’ ability to address the health care needs of their most vulnerable citizens.”
The AMA is a professional organization and lobbying group, which has historically looked out for the financial interests in doctors. In this case that interest aligns with that of patients: more health care for patients means more jobs and money for doctors.
But the AMA isn’t the only group of doctors to oppose the bill. The Americans College of Physicians, America’s second largest physician organization, which consists of internal medicine doctors, also opposes the bill. They released a statement in May, when the house passed the bill, saying the organization was “extremely disappointed” in the bill because it makes:
“… Coverage unaffordable for people with pre-existing conditions, allows insurers to opt-out of covering essential benefits like cancer screening, mental health, and maternity care, and cuts and caps the federal contribution to Medicaid while sunsetting Medicaid expansion. As a result, an estimated 24 million Americans will lose their coverage… we urge Congress to start over and seek agreement need a better source on bipartisan ways to make health care better, more accessible, and more affordable for patients rather than imposing great harm on them as the AHCA would do.”
Despite these groups opposition to the new bill, there is no denying the American healthcare system is in need of an overhaul. According to the OECD, the United States topped the list of healthcare spending in 2015, with 16.9% of the GDP spent in healthcare. Canada, with it’s single-payer system, on the other hand spent only 10.1%. And what are we getting for spending more than one and a half times as much on healthcare? Three years fewer life expectancy, according to the World Bank, with Canadians living to an average age of 82 compared to 79 in the US.
This February, A survey, published in the New England Journal of Medicine showed only half of Primary Care Physicians had a favorable viewed the Affordable Care Act (ACA), but 95.1% stated that regulations protecting the coverage of patients with pre-existing conditions were “very important” or “somewhat important” for improving the health of the U.S. population, a provision slated to be removed according to the house’s bill. Only 15% of those surveyed wanted the ACA repealed, but 73.8% favored making changes to the law.
So, yes, we need to reform healthcare in the United States, but if you ask doctors in the US, the AHCA is not the reform we need.
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