Why we support Dr. Price to lead HHS

Patrice A. Harris, MD, MA
President-elect
American Medical Association
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The AMA supports the nomination of Dr. Tom Price based on decades of interactions with him as a member of the AMA House of Delegates, Georgia state senator and as a member of the House of Representatives since 2005.  Over these years, there have been important policy issues on which we agreed (medical liability reform) and others on which we disagreed (passage of the Affordable Care Act). Two things that have been consistent are his understanding of the many challenges facing patients and physicians today, and his willingness to listen directly to concerns expressed by the AMA and other physician organizations.

An orthopaedic surgeon for nearly twenty years, Dr. Price would be the first physician to serve as secretary of the U.S. Department of Health and Human Services since President George H.W. Bush appointed Louis W. Sullivan, MD, in 1989, and only the third doctor to serve as secretary of the department in its 63-year history. That physician background will provide important perspective within the president’s cabinet. Too often, health policy makers and regulators give short shrift to the real-world impact their plans and decisions can have on how patient care is delivered.

Even prior to his 2004 election to Congress, Dr. Price brought his physician experience to bear on health policy as a member of the Georgia Senate, where he served on the Health and Human Services Committee and supported efforts to improve child safety and expand patient choice. The AMA recognized his state legislative work with the Dr. Nathan Davis Award. More recently, Dr. Price has taken part as a speaker in AMA-organized policy events, such as a 2015 tele-town hall that prompted conversation on how to chart a better course on electronic health records.

An open door

A mainstay through the years has been Dr. Price’s commitment to seek out and hear the concerns expressed by the AMA and other physician organizations. Even so, our support for Dr. Price to lead HHS should not be taken as an endorsement of every policy position he has advocated.

The conversation surrounding President-elect Trump’s HHS choice caused me to reflect on a similar episode in the history of U.S. health care. When Ronald Reagan named pediatric surgeon C. Everett Koop, MD, as surgeon general, the move prompted a flurry of objections based on Dr. Koop’s fervent opposition to abortion.

Despite that early resistance, Dr. Koop went on to become a powerful and constructive voice during the AIDS epidemic, helping to advance education, prevention and treatment responses that reduced stigma, deaths and suffering. He also released eight reports on tobacco use’s baleful health consequences and promoted the goal of a smoke-free society. Dr. Koop’s one-time opponents later cited him as a role model for how the U.S. surgeon general can help the nation face serious health care challenges.

The AMA will actively engage Dr. Price, other leaders in the incoming Trump administration and Congress in discussions on the health system’s future direction. We remain devoted to improving health insurance coverage so that patients receive timely, high-quality care, preventive services and other necessary medical treatments. And for us, a core principle with regard to any proposed health system reform is that it should not cause anyone who has health insurance coverage now to lose it.

We look forward to a continuing conversation with Dr. Price as we work together on the health care priorities where we share common ground.

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Dr. Harris: Your History concerning, Dr. Koop is a bit off the mark. I had the privilege of meeting him and touring him through our childrens' hospital some years ago. The discussion of HIV/Aids came up and he told me that he delayed speaking out for many months for fear of losing his job. He stated, to his credit, that as we talked, he was ashamed of putting his career before lives. While he finally did speak up, it was not the same as the power he could have had if he had spoken earlier. I am, however, grateful that he did become a powerful voice, but always with political appointments comes the ultimate decision of speaking truth to power. For this reason, I am not rushing out to endorse a physician, simply because he is a physician for his history would suggest we may go backwards in time. And only time will tell, won't it. Geni Bennetts MD
Since the AMA was one of the first official supporters of the ACA, I am heartened that the AMA is now supportive of a candidate which may be helpful to fix the unmitigated disaster that President Obama and the democratic party at the time unilaterally strong-armed through congressional passage. Like many, I was one who saw that the ACA formulation was fundamentally flawed and unsustainable, and was more harmful than helpful. From the lack of confidence in the AMA to support medical care of my patients and medical practitioners, I was in the many who cancelled their AMA membership at that time. It may be indeed that I consider rejoining the AMA this next year.
I am surprised at the amount of negative reactions by physicians toward Dr. Price. I hope that it is not politically motivated, although I suspect in a large part it is so. The ACA promised the world, and that is to be applauded, but it did not finance those promises adequately. I just closed my general surgical practice of 30 years because of those shortfalls. Physicians should be the first to know that having insurance does not equate to receiving healthcare. Between high deductibles and poor reimbursement, many people are not accessing the medical system. Many of those people had insurance previously. Physicians have been getting hammered over the last 8 years as the scapegoats for the high cost of healthcare, which is just wrong. Physician reimbursement accounts for only 10-15% of the annual healthcare costs. My reimbursement for an emergency appendectomy (in the middle of the night, in emergent conditions) has risen just 10% (to $550) over the last 19 years; that doesn't even keep-up with the cost-of-living increases. And the reimbursement for Medicaid is significantly lower. According to a report by PricewaterhouseCoopers, the two biggest components of healthcare cost waste in the U.S. are defensive medicine ($200 billion per year) and insurance bureauacracy (also $200 billion per year). But both of these issues were conveniently ignored by the ACA. Dr. Price has been one of few in the government to acknowledge and address these two 800 pound gorillas. And with a reduction in the $400 billion cost of these two issues, access to healthcare of all citizens could be readily achieved. Therefore, I applaud the AMA's endorsement of Dr. Price.
I was embarrassed and dismayed by the AMAs endorsement of Dr. Price for all the reasons outlined above. I am heartened by the above comments and now knowing that there are like-minded members of the AMA. If our agenda truly is better health care access for all Americans, we have a big job ahead of us and the AMA will need to vigorously lock horns with Dr. Price over his policies. The public doesn't know that these types of statements come from the executives at the AMA and do not reflect the opinions of its membership. This endorsement makes me ashamed to be a member.
Shame. A physician who do not advocate for the poor and whose policies will allow physicians to accumulate more cash than they need. I have often met physicians like Dr. Price. I once met a colleague who did not like ACA because he was no longer easy for him to make $600K per annum. Due to emphasis on quality care from the ACA his income had reduced. Like a greedy physician, this provider cared more for himself than the many poor who have benefited from the ACA. Dr. Price policies advocates for less quality and more for aggrandizement of physicians. AMA has not listed these policies which they are probably aware of and yet they have endorsed a greedy physician like Dr. Price. I will list his policies here for the education of others: "Price has sponsored legislation that supports making armor-piercing bullets more accessible and opposing regulations on cigars, and he has voted against regulating tobacco as a drug. His voting record shows long-standing opposition to policies aimed at improving access to care for the most vulnerable Americans. In 2007–2008, during the presidency of George W. Bush, he was one of only 47 representatives to vote against the Domenici–Wellstone Mental Health Parity and Addiction Equity Act, which improved coverage for mental health care in private insurance plans. He also voted against funding for combating AIDS, malaria, and tuberculosis; against expansion of the State Children’s Health Insurance Program; and in favor of allowing hospitals to turn away Medicaid and Medicare patients seeking nonemergency care if they could not afford copayments. Price favors converting Medicare to a premium-support system and changing the structure of Medicaid to a block grant — policy options that shift financial risk from the federal government to vulnerable populations. He also opposed reauthorization of the Violence Against Women Act and has voted against legislation prohibiting job discrimination against lesbian, gay, bisexual, and transgender (LGBT) people and against enforcement of laws against anti-LGBT hate crimes. He favors amending the Constitution to outlaw same-sex marriage. In addition, he has been inconsistent in supporting investments in biomedical science. He opposes stem-cell research and voted against expanding the National Institutes of Health budget and against the recently enacted 21st Century Cures Act, showing particular animus toward the Cancer Moonshot. Price has also been a vociferous opponent of the Affordable Care Act (ACA) and a leader of the repeal-and-replace movement. His proposal for replacing the ACA is H.R. 2300, the Empowering Patients First Act,5 which would eliminate the ACA’s Medicaid expansion and replace its subsidies with flat tax credits based on age, not income ($1,200 per year for someone 18 to 35 years of age; $3,000 for someone 50 or older, with an additional one-time credit of $1,000 toward a health savings account). Price’s plan is regressive: it offers much greater subsidies relative to income for purchasers with high incomes and much more meager subsidies for those with low incomes. In today’s market, these credits would pay only about one third of the premium of a low-cost plan, leaving a 30-year-old with a premium bill for $2,532, and a 60-year-old with a bill for $5,916 — along with a potential out-of-pocket liability of as much as $7,000. By contrast, subsidies under the ACA are based on income and the price of health insurance. Today, a low-income person (with an income of 200% of the federal poverty level) pays, on average, a premium of $1,528 per year (regardless of age) for a plan with an out-of-pocket maximum of $2,350, and that payment does not change even if health insurance premiums rise. His Empowering Patients First Act would directly advance physicians’ economic interests by permitting them to bill Medicare patients for amounts above those covered by the Medicare fee schedule and allowing them to join together and negotiate with insurance carriers without violating antitrust statutes. Both these provisions would increase physicians’ incomes at the expense of patients. Price has consistently fought strategies for value-based purchasing and guideline development, opposing the use of bundled payments for lower-extremity joint replacements and proposing that physician specialty societies hold veto power over the release of comparative effectiveness findings. These positions reduce regulatory burdens on physicians at the cost of increased inefficiency and reduced quality of care — " from NEJM.ORG
I am very disappointed in this endorsement and seriously considering whether or not to continue my AMA membership. While imperfect, the ACA has greatly advanced the cause of making quality, affordable health care available to all - and most well-informed people know that. Politically motivated, often ill-informed opponents have aggressively misrepresented the ACA, so that many (?most) of the voting public really doesn't understand what it is. The leading national physician organization should show some backbone and make it clear that our FIRST priority is promoting the health of our communities, and that "repeal" of the ACA without a darn good, thoughtfully crafted replacement that improves upon it, is unacceptable - and I see no evidence that such a replacement exists. And what is this about supporting a "market based" approach to fair drug pricing? - how naïve! The pharmaceutical industry has demonstrated unfathomable greed in pricing so many drugs out of the reach of so many who need them, and contributing greatly to the spiraling costs of care that affect all of us - at the same time that they are posting huge profits - I have seen no sign of any "market based" solutions to that problem. Let the politicians play politics if they must. The American people still look to doctors to speak out strongly on their behalf - more than ever, it behooves us now to do just that, not to meekly try to seek accommodations with those with political clout. We have some clout too - please, let's use it to do right by our patients.

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