Letters to the Editor - July 26, 2004

The AMA should back movement to collect liability surcharges - Liability surcharges will be seen as a physician "money grab" - Use medical savings accounts to take back medicine from insurers, HMOs

The AMA should back movement to collect liability surcharges

Regarding "AMA to study liability surcharges" (Article, July 5): My practice's bottom line dropped 35% last year, largely due to a doubling of my malpractice premium, and fixed reimbursements from Medicare and insurers.

The AMA must take action to assure that physicians can continue to serve their patients without going bankrupt.

It is clear that Medicare and insurers don't care that their reimbursements don't cover our real costs. Congress certainly doesn't seem to care that the physician reimbursement formula remains broken. We must have some mechanism by which costs can be passed on to consumers, as in any other business.

The AMA must not conclude somehow that it is unethical to pass these costs on. We can't serve patients if we are out of business.

It would be unethical for the AMA to fail to take all necessary actions to prevent the collapse of physician practices, which would lead to terrible access problems.

Unless the AMA can compel Congress to increase not only relative value units but also the conversion factors to adequately keep pace with these true costs, the AMA must advocate ways that allow doctors to legally pass these costs on to consumers.

There are real economic costs associated with taking call, returning phone calls, arguing with insurance companies on behalf of our patients, writing prescriptions and simply being there for our patients.

Attorneys, accountants, financial planners, and all other professionals don't give their services out gratis like physicians have been expected to. Now that the third-party payer system has bled the profits completely out of medical practices, we simply can't afford to continue as we have and be expected to keep the "open" sign in the window.

--Benjamin T. Hu, MD, Coupeville, Wash.

Liability surcharges will be seen as a physician "money grab"

The action taken by the AMA House of Delegates to study liability surcharges (Article, July 5) finds me once again frustrated by this professional organization. As a family physician who trains residents and does obstetrics, I see rising malpractice premiums driving good family doctors out of doing OB.

This problem cannot be addressed in isolation, however. As a profession, we must first and foremost advocate for our patients (part of the definition of professionalism). We must advocate loudly for, dare I say, universal access to comprehensive health care for all Americans and not continue to support incremental changes that appear to be driven by our self-interest. This is how we will ally the public to assist us with this problem, not by adding surcharges that will be perceived as another "money grab" by physicians.

Physician malpractice and income concerns are important, but single focus on these issues reflect poorly on our profession. We would serve each other and the public better if the AMA acted more as a professional organization (patient advocacy) and less as a trade union (self-advocacy).

--Tim Lambert, DO, Traverse City, Mich.

Use medical savings accounts to take back medicine from insurers, HMOs

Regarding "Know your worth: A few last words from AMA chair" (Column, July 5): I whole heartedly support the commentary by former AMA Board Chair William G. Plested III, MD.

Physicians have no one but themselves to blame for the current state of affairs. The mega-insurance companies and HMOs would never have achieved their current level of success and dominance without the complicity of physicians.

We are the only ones who are trained, qualified and licensed to provide care. Our participation in their plans (albeit often reluctantly) has allowed these entities to loot billions of health care dollars for corporate profit and administrative salaries all at the expense of patient care and physician and hospital reimbursement. Sooner or later we need to grow a backbone and stand up and say "No more!"

We have to be the ones to take back medicine for the sake of our patients and our profession; no one else will do it for us. We have an opportunity to do so now with the availability of medical savings accounts. We should all be lobbying for expansion of this program.

I propose expansion of medical savings accounts (MSAs) making them available to all. This approach is a viable option that removes the intrusive third party from health care decisions and re-establishes the true doctor-patient relationship.

This option would be a win-win-win situation as patients can have affordable self-directed care, physicians will get fair reimbursement for their work and profits from the program could decrease liability premiums, which in turn would keep the cost of providing care down, thereby further benefiting our patients.

The only losers in this scenario are the managed care and insurance behemoths and the government bureaucrats and politicians who are drooling over the prospect of controlling our health care and our profession. Don't count on the government or insurers to solve our health care problems, (they are the problem, not the solution) but rather take action yourself and work with your colleagues, patients and the AMA before this opportunity passes.

--Roderick Brown, MD, Glenwood, Minn.