Sarasota doctors lead push against health reform bill

David Gulliver - posted 8:30 pm Tuesday, Aug. 11

The American Medical Association’s endorsement of the leading health care reform bill, H.R. 3200, has allowed President Obama and Congressional leaders to say doctors are behind the plan, a vital vote of support.

But with the bill inching forward, Sarasota County doctors led an effort that presses the Florida Medical Association to publicly break with the AMA’s backing of the bill.

At the Florida Medical Association’s annual meeting, Dr. Julio Gonzalez, a Venice orthopedic surgeon, submitted a resolution that required the FMA to tell the AMA of its opposition to elements of H.R. 3200 that conflict with the state association’s principles. It also called on FMA to urge the AMA to withdraw its support of the bill if the finished product contains provisions that conflict with those principles.

(On Tuesday morning, Gonzalez announced he has applied to Florida Gov. Charlie Crist to be considered for the retiring Sen. Mel Martinez’s Senate seat.)

After what members described as an occasionally heated debate, the resolution, backed by the Sarasota County Medical Society and the Florida Orthopaedic Society, passed with about 80 percent of the roughly 350 voting members present.

FMA is now preparing a draft letter to the AMA, Gonzalez said. FMA did not respond to a call and email seeking comment.

All three physician groups -- the AMA, FMA and the Sarasota County Medical Society -- are widely seen as leaning politically conservative. But Michael Patete, a Venice ear, nose and throat specialist, and a new member of the FMA Board of Governors, said the opposition has nothing to do with party affiliation.

“This is not a Democratic or Republican issue,” he said.

Gonzalez and Patete said the health reform bill breaks from the FMA’s Principles on Health System Reform on several key points.

FMA favors health savings accounts and high-deductible health insurance, measures that get put patients in control of their own health care spending. Members want to see Medicare patients allowed to contract privately with doctors outside the system. And they also favor malpractice reform and caps on damages. The Congressional bills addresses none of those issues, they said.

The Sarasota and Florida physician groups do support two key concepts in the bill: a means to buy health plans offered in other states, and a national health plan that would cover the poor and those with pre-existing conditions. But they disagree with the mechanisms.

“We don’t have any problem with a universal safety-net plan,” Patete said. “We absolutely think that’s the right thing to do, but no to mandate it.”

One version of the plan under discussion would have made it mandatory for Americans to have health insurance, akin to the system in Massachusetts, though Senate leaders lately have indicated the mandate will be dropped.

The FMA reform principles documents opposes a “public option” health plan financed by the government.

The associations also see the bill’s “national insurance exchange” -- a way that people could buy any plan offered anywhere in the country -- as crucial. “We think that is an extremely viable situation, because now you’re putting insurance companies feet to the fire,” Patete said.

But they see a government-run public plan as something that could be too much competition for the private plans. “The public option is gong to compete so effectively that eventually we’ll be left with a single payer,” Gonzalez said.

The state and national physicians’ groups have tempered their support of the Congressional effort. AMA’s primary reason for backing H.R. 3200 is that the bill will throw out the sustainable growth rate formula that restricts what Medicare pays doctors, a longtime crusade for the association.

Doctors’ groups say the SGR uses flawed components, like estimates of local price increases, and leads to random-seeming cuts in payments for some procedures. It has become the subject of an annual dance in Washington, where Medicare’s parent agency announces 5 percent rate cuts, and then lawmakers scramble to suspend the cuts.

The AMA also likes the bill’s improved Medicare pay for primary care, support for wellness and prevention, and more health care access for the uninsured. Some state and local associations say the bill sacrifices too much for a win on the SGR formula. Seven state medical associations and other groups, including the Sarasota County Medical Society, have signed a letter calling for many of the free-market provisions in any healthcare reform plan.

Last week, FMA’s new president laid out a sort of neutral position, declining to join in either the state groups’ letter or the AMA’s endorsement.

“The FMA does NOT support HR 3200. We chose not to participate in a letter to Congress co-signed by many smaller states repudiating the endorsement of the AMA,” newly elected President James B. Dolan wrote in his weekly column.

“We felt it more prudent to not undercut the AMA, which for better or worse is seen by Congress as speaking for the physicians of America. Instead, like other large states, we sent a letter delineating the ideal “do’s and don’ts” of health care reform as determined by the FMA Board of Governors.”