As legislators await a Congressional Budget Office accounting of Senate Majority Leader Mitch McConnell’s new “secret” healthcare bill — written behind closed doors and revealed last Thursday — big players with a vested interest are coming out and lambasting the bill before it’s even been scored. The American Medical Association, one of the nation’s largest healthcare lobbying groups, even went so far Monday to say the bill ALREADY violates a primary tenet held sacred in the medical profession: Primum non nocere, or ‘first, do no harm.’
The American Medical Association (AMA) wrote a letter to Senate Majority Leader Mitch McConnell (R-Ky.) and Minority Leader Charles Schumer (D-N.Y.) warning against cuts to Medicaid and changes to ObamaCare’s subsidies and regulations. “Medicine has long operated under the precept of Primum non nocere, or ‘first, do no harm.’ The draft legislation violates that standard on many levels,” AMA Executive Vice President and CEO James Madara wrote in the letter. “We sincerely hope that the Senate will take this opportunity to change the course of the current debate and work to fix problems with the current system,” Madara added. “We believe that Congress should be working to increase the number of Americans with access to quality, affordable health insurance instead of pursuing policies that have the opposite effect, and we renew our commitment to work with you in that endeavor.”
Without casting too many aspersions, especially since I haven’t done a deep dive into the new bill, I’m always struck by the tendency in Washington, DC to assert something is definitely going to happen as the result of legislation before any practical application occurs. In the case of a replacement for Obamacare, the emphasis always seems to be on the loss of coverage for some projected number of people who, clearly, will then be on death’s door immediately following their loss of insurance coverage. In McConnell’s bill — and in Ryan’s bill to replace Obamacare introduced in May and promptly tossed aside as a definite people killer (I’m only half kidding) — the issue is the rolling back and eventual phasing out of Medicaid, a program many lower-income people rely on for health insurance. The AMA believes, according to Forbes, that caps on Medicaid based on state per-capita standards will fail the most vulnerable because costs are changing all the time and fixed caps won’t allow a state the flexibility in coverage they may need.
“Per-capita caps fail to take into account unanticipated costs of new medical innovations or the fiscal impact of public health epidemics, such as the crisis of opioid abuse currently ravaging our nation,” AMA’s Madara said. “The Senate proposal to artificially limit the growth of Medicaid expenditures below even the rate of medical inflation threatens to limit states’ ability to address the health care needs of their most vulnerable citizens,” he added. “It would be a serious mistake to lock into place another arbitrary and unsustainable formula that will be extremely difficult and costly to fix.”
Again, I’ll reserve a lot of judgement except to say two things I know to be true and that I suspect make these fears a little less founded in reality: 1. Medicaid was always the manifestation of single-payer system that Obamacare was trying to get to. It already existed and, my understanding anyway, was that when the Obamacare exchanges started to break down and the registration process stopped working (which was immediately after the rollout of Obama’s signature healthcare law), Medicaid was the program users were asked to enroll in for the time being while the problems were sorted out. I don’t think it’s unfair, in hindsight, to believe it’s at least reasonable to suggest those problems were never meant to be sorted out. And, 2. Because Obamacare necessarily decimated the private insurance market (with their blessing as it turns out), it’s reasonable to think that without the regulations that accompany government-funded single-payer healthcare, there will be room for the private market to once again rise from the ashes like a beautiful free-market phoenix, lowering costs and making innovation and flexibility in the market affordable. And anyway, it might not be fair, but I also know this to be true and it makes me suspicious:
For context: the American Medical Association endorsed Obamacare in 2009 https://t.co/pemBIrfU8c
— Bradd Jaffy (@BraddJaffy) June 26, 2017