‘AMA on the Offensive’

We are disappointed in your negative characterization (“AMA on the Offensive,” editorial, July 3) of our educational campaign to tell people, through the media, about the ramifications of expenditure targets.

The basic problem with the so-called expenditure targets (ETs), which Rep. Pete Stark (D-Oakland) and the Bush Administration have successfully sidestepped and your editorial board has missed, is that they would cut funding for Medicare at time when more elderly are coming into the system and using more medical services.

Moreover, they would tend to reduce all kinds of medical services indiscriminately, not just those that are inappropriate. By way of contrast, the American Medical Assn. is proposing to expand the use of practice guidelines or parameters. These would help to save money by reducing only the inappropriate or unnecessary services.

The avowed purpose of ETs is to achieve the Administration’s budget cuts. While this will help to finance the Administration’s $157 billion decision to bail out the savings and loan industry, cutting back on payments to physicians who treat the elderly will ultimately force them to limit care in order to keep up their practices without financial loss.

More to the point, the ET approach is just a Band-Aid to mask the real Medicare crisis--the lack of a firm financial footing. Here again, the AMA has pioneered a sound legislative proposal, H.R. 2600, that would rescue Medicare from its rendezvous with bankruptcy, and help assure the program’s hard-earned benefits to those who supported Medicare throughout their working lifetimes.

In the final analysis, it matters not one whit what I or members of Congress or President Bush all think. What matters is what our nation’s elderly will think--and how they will react--to this mean-spirited assault on the health care benefits they have toiled all their lives to pay for.

If ETs become law, I sincerely hope that the citizens of California, especially the elderly, will remember how a shortsighted Congress, an uncaring Administration, and your newspaper all supported this dreadful idea when they begin to feel the effects of expenditure targets on the amount of care that is available to them.

C. JOHN TUPPER, M.D.

President-Elect

American Medical Assn.

Chicago