The AMA Has Some Explaining To Do
ON TUESDAY, November 29, President-elect Donald Trump named Dr. Tom Price, a former orthopedic surgeon, current Republican congressman and chair of the House Budget Committee, as his pick for Secretary of Health and Human Services.
The same day, the American Medical Association issued a press release enthusiastically endorsing Price for the position.
The next day, Dr. Andrew Gurman, the president of the AMA, came to my hospital to give grand rounds. He was shouted down by protestors in the audience, who demanded an explanation for his organization’s support of a public official committed to dismantling the Affordable Care Act and revoking the health insurance of millions of people.
Dr. Gurman did not attempt to defend Dr. Price’s policies—some of which are extreme—offering only that the two of them have been friends for 25 years and that Price is a “good man.”
He did not add any provisions to the AMA’s endorsement or even try to answer the nagging question on everyone’s mind: How could the body that purportedly represents America’s doctors back a politician whose proposals are so hurtful to their patients?
If Americans have learned anything from this past election cycle, it’s that “endorse” and “condone” don’t necessarily mean the same thing (see: Exhibit A). But it’s safe to say the AMA endorsed Price not just because he is a good man, but because it agrees with at least some of his policies.
Price is proposing...a massive
cut to Medicaid, for which the
poorest will suffer.
So rather than talk about what kind of person Dr. Price is, let’s look at what Representative Price the lawmaker proposes for his overhaul of the U.S. health care system:
Dr. Price wants to repeal the Affordable Care Act, the major legislative achievement of the Obama presidency. Not just modify it, as Trump has hinted at in recent days, but abolish it and replace it with something very similar to the tried-and-failed free market model of the past several decades.
He also wants to reverse the expansion of Medicaid that happened under Obamacare, which gave millions of low-income Americans access to health care and reduced the uninsured rate to 8.6%. The Congressional Budget Office estimates that this cut would result in 14 million people losing their health insurance.
Speaking of Medicaid, Price is proposing a whole new way to fund the safety net program using block grants. Currently, Medicaid is a cost-sharing agreement between states and the federal government; they split the bill, no matter how many people are insured or how costly their care is. Block grants would cap the amount the federal government is willing to contribute, leaving it to states to divvy up the funds and make up the difference. No matter how you look at it, block grants represent a massive cut to Medicaid, for which the poorest will suffer.
Price wants to defund Planned Parenthood. Yes, nearly every Republican member of Congress wants to defund Planned Parenthood, and history has shown that it’s easier said than done. But with majorities in both houses, a Republican president, and Price leading HHS, they may finally get their wish.
Lastly, and perhaps worst of all, Price dreams of turning Medicare into a “voucher" system, handing over a sum of money to beneficiaries to buy their own insurance from private companies. This plan would essentially eliminate the popular government-payer program as we know it. Remember the widely-mocked “Keep government hands off my Medicare” protests during the Obamacare rollout? Get ready for Round 2.
There is no reason to believe Dr. Price as HHS chief wouldn’t enact these proposals if he wanted to; there is little standing in his way. So how can the AMA, an organization that supported the Affordable Care Act and whose mission includes the “betterment of public health,” offer a good-faith endorsement of this vision for American health care?
I am sure Dr. Price is a good man; frankly, it is irrelevant. The AMA owes its constituency—doctors and patients alike—a better explanation.
Note: A version of this article appeared on KevinMD.com on December 8, 2016.