AMA on the Offensive

Leaders of the American Medical Assn. have unleashed a double national campaign opposing legislation that would place caps on doctor payments under Medicare and publicizing what they regard as the “deficiencies” of Canada’s health system. It looks a bit like a reversion to the days when the AMA fought Medicare and Medicaid and vilified Britain’s national health care.

The sensitivity of organized medicine may be understandable. Both the target expenditures under consideration for physician payments in Medicare and the Canadian model of universal health insurance are methods of limiting what doctors can charge. Similar limits already have been applied to hospitals serving Medicare patients with resultant savings.

What is less understandable is the deceptiveness of the campaign. Canadian medicine is being portrayed as “socialized,” whatever that means, and as restrictive in care. The national and provincial governments do indeed play a part, but essentially it is universal insurance that rations care by limiting access to high technology in much the same way that American medicine rations care by excluding 37 million Americans from any form of health insurance. The expenditure targets for Medicare, recommended by the Physician Payment Review Commission created by Congress, is being portrayed also as a means of rationing care when it would be more accurate to say it is a means of rationing payments to doctors. It was proposed only when every other effort to contain medical inflation was circumvented by a proliferation of procedures, tests and other services.

The Canadian model is not likely to be translated to the United States, but American doctors would do well to recognize that it delivers care of equal or higher quality at substantially less cost. The expenditure targets for Medicare may not be a perfect answer, but they hold more promise than the practice guidelines now being advocated by some AMA officials.