Despite differences, Obama and medical community vow reform

President Obama said he knew he was addressing a skeptical audience at the American Medical Association Monday, which is why he made a point to connect the issue of healthcare reform to the rebuilding of the nation’s troubled economy.

“If we do not fix our healthcare system, America may go the way of [General Motors]: paying more, getting less, and going broke,” Mr. Obama said in Chicago. His keynote address at the AMA's annual meeting not only offered a broad-brush outline of his plans to curtail spiraling healthcare spending, but also addressed critics far and wide who suggest the president is advocating a single-payer system.

“When you hear the naysayers claim that I’m trying to bring about government-run healthcare, know this: They are not telling the truth,” Obama said.

The audience of doctors Monday was certainly not hostile, showering Obama with applause whenever he spoke up for patient healthcare and against the bureaucracy of the current system. But some issues Obama stressed stung, particularly his unwillingness to cap malpractice awards. In the end, the doctors and the AMA, always a major player in any healthcare reform debate, proved to be wary about jumping on his bandwagon in the absence of greater detail about his plan.

Back in Washington, the Congressional Budget Office said Monday that one of the reform bills under consideration in Congress would cost the government an estimated $1 trillion over the next decade and reduce the ranks of the uninsured by about one-third, or 16 million individuals. Obama has vowed that the overhaul will not add to the deficit and, so far, has proposed nearly $1 trillion in savings through spending cuts and tax increases to finance it.

Physicians in the audience seemed familiar with most of Obama's reform proposals. Many knew of his plan to bundle healthcare services, which would charge patients for overall care, not necessarily for individual visits. They were, for the most part, aware that he wants to allow consumers to choose the level care they can afford.

During the one-hour speech, Obama received generous applause when he mentioned his aim is to free up doctors from the cumbersome business of dealing with insurance companies, and to avoid changes that make doctors “feel like they are constantly looking over their shoulder for fear of lawsuits.”

But the president received some jeers over his unwillingness to cap malpractice awards, saying such limits “can be unfair to people who’ve been wrongfully harmed.”

“Based on your response, it is a priority for you,” Obama said, in recognition of the audience reaction.

Richard Vienne, an internist with the Medical Society of the State of New York in Buffalo, said afterward that capping damages in malpractice cases “is a huge issue for us.” The rising amounts sought in malpractice suits “have affected our ability to take care of patients.”

In a briefing with reporters after Obama spoke, AMA President Nancy Nielsen said the association “knew [Obama] was opposed to caps.”

“That’s not a surprise," said Dr. Neilsen. "What we were really pleased about is he acknowledged the issue and put it into the context of healthcare costs.”

She stressed that the AMA wants to work with the president to make real reform possible by improving the quality, availability and delivery of health services, but was cautious in seeing how his proposals would work compared with alternative the organization is currently exploring.

"What we have done is try to be open to whatever possibilities are actually in play.... We await any options that come forward," she said.

For Richard Whitten, an internist with the Washington State Medical Association, the $950 billion in savings measures Obama dissected in his speech didn’t add up. He is hesitant to support, for instance, the president’s proposed bundled payment system because “we don’t have a system in position to do that yet,” he said. “The details on how that’ll work are just not there.”

Dr. Whitten said “it was a shock” to hear Obama say he wanted to eliminate overpayments to the Medicare Advantage program, which allows private companies to offer Medicare coverage. Many doctors see Medicare Advantage as costing patients much more and as leaving too much decisionmaking about medical care to private insurance companies.

“I think he energized a lot of physicians right there," Whitten said. "It’s been a protected area for quite a period of time … that’s a very strong statement for him to make."

Obama frequently emphasized his concern about the uninsured – the issue that seemed to resonate the most with his audience.

“We want to achieve the goal of affordable health insurance of all Americans,” said AMA President-Elect J. James Rohack after the speech. “Under the current system … the uninsured live sicker lives, they die younger, and all of us pay a premium tax. That’s not good for America if that’s the model.”

Material from Associated Press was used in this report.