Enough unhappiness to go around

The Times has several related articles today about Obama's upcoming speech to the American Medical Association today. One thing seems clear to me -- he's going to generate a lot of heat across the political spectrum.

From the AP article:

The nation's doctors, like many other groups, are divided over the president's proposals to reshape the health care delivery system. The White House anticipates heavy spending to cover the almost 50 million Americans who lack health insurance and has taken steps in recent days to outline just where that money could be found.

For instance, Obama wants to cut federal payments to hospitals by about $200 billion and cut $313 billion from Medicare and Medicaid. He also is proposing a $635 billion ''down payment'' in tax increases and spending cuts in the health care system.

While the direct impact of a cut to hospital payments will be felt by the hospitals themselves, it's hard to imagine that the cuts won't find their way into physician compensation. One hopes that this would be felt more by subspecialists than primary care physicians, but that remains to be seen. Considering how much representation the former have in the AMA, color me skeptical.

However, as I have already said, the following is also true:

Momentum might be on Obama's side. Aaron Carroll, an Indiana University medical professor who has surveyed doctors' views on U.S. health care delivery, said 59 percent ''favor government legislation to establish national health insurance,'' an increase over a previous poll's finding.

He noted that many doctors are not AMA members, and therefore the association's views should not be overrated.

If the Obama administration perceives the AMA as being obstructionist, they may be less inclined to placate its members. I hold out hope that this might translate into a relative shift in compensation away from expensive procedure-based medicine, and toward primary care. (That would be a good thing.)

The President also seems willing to consider something that is sure to annoy members of his own party. From the article by Times reporters:

In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials.

Good. If they are hoping to reduce health-care costs, limiting the unnecessary tests and procedures ordered as a part of "defensive medicine" is an important step. In addition, if Obama is expecting doctors to accept a likely reduction in compensation, he has to offer something to make reform palatable.

Unsurprisingly, this isn't making everyone happy:

But to deliver a deal with doctors, Mr. Obama would probably have to defy senior members of his party in both houses of Congress. Many Democrats oppose putting limits on medical lawsuits because they believe it is ineffective and unfair to patients.

Senator Max Baucus of Montana, the chairman of the Senate Finance Committee, is expected to outline his proposal for a health care overhaul this week, and aides said liability protection for doctors is not part of the plan.

Senator Harry Reid of Nevada, the Democratic leader, resisted medical malpractice legislation when it was pushed by Republicans in the past. “The whole premise of a medical malpractice ‘crisis’ is unfounded,” Mr. Reid said on the Senate floor in 2006, in a speech that quoted extensively from a book titled “The Medical Malpractice Myth.”

And any effort to restrict patients’ legal rights to sue will face tough opposition from the American Association for Justice, which represents trial lawyers and has met with Nancy-Ann DeParle, Mr. Obama’s point person for health reform, to express its concerns. Linda Lipsen, the association’s chief lobbyist, said practice guidelines were established by unregulated medical societies and “should not be conclusive” in a court of law.

Harry Reid can shut his pie-hole, as far as I'm concerned. The culture of fear that pervades contemporary medical practice most certainly contributes to health-care costs, no matter what his book. And, just as the AMA is out to protect the interests of its members, it's hardly a surprise the the trial lawyers' lobby would be opposed to malpractice reform. Whether Obama listens to them remains to be seen.

I'm willing to hear what the President has to say, and will try to post about the text of the speech when it becomes available. But it seems plain to me that, beefs with the AMA notwithstanding, he's going to have to give doctors something if he expects us to accept a cut in pay.