On the Side of the Uninsured

Since 1847, the American Medical Association has been fighting for high quality healthcare for all Americans. Joseph Heyman brings us up to date on the association's latest campaigns.

Member of the Board since 2002

“We're asking Congress to have the political will to sit down and find a compromise that will work for everybody”
-Joseph Heyman, Chairman of the Board of Trustees of the American Medical Association

The current crisis in the financial markets is raising concerns across many sectors, and healthcare is not exempt. With more people losing their jobs, the number of unemployed is sure to rise, and in our country being unemployed often means having no health insurance.

Joseph Heyman, Chairman of the Board of Trustees of the American Medical Association, is well aware of these concerns. “When there is a loss of jobs, since most people who are insured in the United States receive their insurance from their employer, there will be an increasing number of people who have no health insurance, and we know that those people live sicker and die younger because of this.

“As an association, we’re very concerned about that, which is one of the reasons we’re pushing for a plan that would cover everybody. There will be tremendous window of opportunity immediately after the inauguration of the new President to accomplish this. The amount of money we’re spending on trying to fix the economy dwarfs what it would cost probably to provide additional insurance to those people who are not insured now. This is an issue that has to be addressed, no matter what the situation in the economy is.”

To this end, the association has instituted the Voice for the Uninsured campaign. As Heyman explains, the campaign was rolled out in three stages. “The first stage was to raise the issue so that people would think about it. The second stage was to make certain that everyone knew there’s at least one plan out there that could accomplish everything we need to do to get people insured.

“The third stage was to be able to influence what’s going on in Congress. We’re at the third part of the campaign now, which started immediately after the election, although we were speaking with members of Congress and with both campaigns before that to try to come to some advance agreement about the plan.”

The association maintains a website called voicefortheuninsured.org, which has received about 5000 messages from uninsured patients willing to share their stories about the problems caused by not having health insurance.

“I live in Massachusetts, which is a state that recently did pass some health insurance reform that aims to insure almost all of its citizens,” Heyman says. “We’ve insured about 600,000 more than had insurance two years ago. We realized in Massachusetts that what we really need is the political will to accomplish this; even if the numbers don’t add up, if you have the political will to accomplish it, you can get it done.

“What the association is doing is asking Congress to have the political will to sit down together and find a compromise that will work for everybody, and we think that’s possible.”

Public interest

This advocacy on the part of the American public is not a new direction for the AMA – the association was founded in 1847 on a code of ethics that puts patients’ interests before those of the physicians. The healthcare reforms the AMA is proposing include the expansion of health insurance coverage to every citizen, a campaign it started back in 1991.

“We’re in the middle of a big campaign that has been using a tremendous amount of resources to promote our plan and to promote some change, even if it isn’t our plan, in the US healthcare system,” Heyman says. “This included millions of dollars worth of advertising and behind-the-scenes discussions with both presidential campaigns, and we’re excited about the opportunity for making some progress in this regard.”

Among the other campaigns the association is currently working on is its opposition to tobacco companies. The AMA has asked the companies to refrain from engaging in advertising practices that target children, it has tried to get the FDA to regulate cigarettes as a drug, and has also expressed its concern about the use of tobacco not only within the United States, where it has dropped dramatically, but also throughout the world.

“Another thing we’ve been working on is getting antitrust relief for physicians and patients, which we’ve been working on since 1996,” Heyman explains. “We aim to make it possible for physicians to negotiate as a group rather than as individuals, where the balance of power is so extreme on the part of insurance companies.

The AMA has also led a crusade against health plan gag clauses, which prevented physicians describing all of the possible ways in which a patient could be treated if they were not covered by their insurance, prevented them from explaining that there were things not covered by insurance companies that were very important, and prevented them from complaining about the insurance companies. These gag clauses were eventually rescinded.

In conjunction with the National Medical Association – the association of African-American physicians – and the National Hispanic Medical Association, the AMA has created a commission to end healthcare disparities in the US. This is comprised of leaders from the nation’s largest physician organizations and more than 30 health-related groups, with a mission is to educate physicians and healthcare professionals about disparities.

Other notable initiatives have included a campaign against ‘ drive-through deliveries’: when a woman was admitted have a baby and then discharged on the same day without adequate time in the hospital; and responding to September 11, 2001, when the AMA provided the government with a list of 3500 volunteer physicians who were ready and willing to assist in the recovery efforts.

As a result of 9/11, the association developed a disaster preparedness and medical response website where patients and physicians can go in the event of another disaster, which was called in to use during Hurricane Katrina.

Dropping payments

Every year since 2001, the AMA has been involved in fighting the drop in payments to physicians. “We have a problem with a formula for payment to physicians under Medicare, where our payment amounts are based on the volume of care from the previous year. Every year there’s been a projected drop in payments for the following year, and every year at the end of the Congressional session we spend a lot of money and expend a lot of energy trying to prevent the drop, and every year we’ve either we’ve had a freeze or we’ve had a tiny increase in payments, and it hasn’t kept up with inflation.

“This year the projected drop was almost 11%, which was a terrible problem for us because if this happened, patients with Medicare would not be able to see physicians because physicians can’t afford to provide care at such a low price. Everybody in Congress was committed to fixing this, but at the end of the year, when the vote came right before the July 4 weekend, we were short a couple of votes, and the then President had threatened to veto it, so we were very, very worried.

“Over the July 4 weekend, we put together an incredible campaign. In states where people were up for re-election who voted against us, we put up campaign ads over the weekend, asking their constituents to call on them to change their vote, and by the time the weekend was over, we not only had enough votes to pass it, but in addition to that we actually overrode the Presidential veto.

“The outgoing President has a pet project that he calls Medicare advantage plans – private plans that provide Medicare, with Medicare giving them a subsidy to pay for the care – and we wanted to use that subsidy to pay for the increase in payment. That was the reason behind his planned veto of the bill.

The end result of this campaign was that the subsidy no longer exists and that physicians are being paid more than they would have been paid. An 18-month reprieve was also introduced, given the association more time to work on a new formula for payment.

“It was such an important issue that Senator Kennedy came to the House to vote in the second vote, the only time he has done so since being diagnosed with a malignant brain tumor,” Heyman recalls. “He was given a standing ovation in the Senate, so it was a pretty exciting moment.”

National reform

Much of he AMA’s current advocacy efforts focus on its push for nationwide healthcare reform, and addressing the predicted shortfall of 85,000 physicians in many medical specialties by 2020. Heyman outlines the association’s recommendations.

“We need to increase medical school class size, allow for additional residency slots to train physicians, and somehow improve the distribution of physicians to underserved and undersupplied specialties. We must create incentives for those who choose to practice in an area where they’re needed rather than in an area that’s particularly attractive.

“Re-entry programs that address the educational needs of physicians who re-enter the workforce after there’s some inactivity will ensure that they’re current and proficient in their practice areas. And we must improve the attractiveness of careers in primary care. We need to do something about the educational system to make certain that people who do choose primary care realize that they’re doing something special that’s very, very important to our country.

“Physician reimbursement changes need to be encouraged for those who are practicing, especially in primary care, and we need to look at innovative models, perhaps considering models like the patient-centered medical home model or other innovations in which we can increase payment to primary care physicians.”

That’s not to say that our healthcare system doesn’t have its good side, as Heyman points out. “We have a lot of problems with our healthcare system, most of which involve the fact that people are uninsured, but our system does have desirable features. The main one of these is choice – patients can choose the kind of insurance they want, they have a choice of physicians, they have a choice of hospitals. We also provide a tremendous ability to innovate, and we have very convenient access to care where people don’t have to wait very long. Those are places in which we really shine.

“As far as quality and safety is concerned, we’re working hard to achieve constantly higher quality and safety across the healthcare system. We’ve tried all kinds of different ways in which to improve quality and safety. Most citizens in the United States feel that they have a very high quality healthcare system. As an association, we’re not satisfied, but I think most people are.”

Challenging future

Heyman has faced a range of challenges in his time with the AMA, both personal and from the point of view of the association. “Personally, trying to keep up with my own practice at the same time as fulfilling my role as Chairman at the AMA has been a little difficult. I’m in solo practice, and that’s been hard to divide my time up. Also, trying to stay on top of all of the issues that the AMA confronts is very challenging.

“That said, this year has been a real highlight of my life. Being able to involve myself in something that affects so many people and having the opportunity to make things better has been amazing. I’ve been learning every day, I’ve been meeting incredibly talented people, and it’s been a delight.”

“From a broader viewpoint, I’m an eternal optimist, and I’m very optimistic that there is a bright future for American medicine. We will have greater emphasis on prevention and much wider use of health information technology. As a solo practitioner, but I’ve been paperless since 2001, and I believe that health information technology will eventually make a dramatic difference to our healthcare system.

“We’re looking for a more efficient healthcare system, and the American Medical Association is going to continue to be at the forefront when our law-makers are searching for practical solutions to the nation’s healthcare priorities, and we’re going to do our very best to pave the way for establishing realistic, practical solutions. We’re striving to provide everyday solutions for our member physicians that hopefully will make us indispensable to physicians in the future.”

Joseph Heyman is Chairman of the Board of Trustees of the American Medical Association. The board is charged with making strategic decisions about the future direction of the association. Policy decisions are made by the House of Delegates, and the board works to implement those decisions through its relationship with senior management and staff at the association.

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The American Medical Association

Mission: To promote the art and science of medicine and the betterment of public health.

Core values: leadership, excellence, and integrity and ethical behavior.

Vision: To be an essential part of the professional life of every physician.

The American Medical Association helps doctors help patients by uniting physicians nationwide to work on important professional and public health issues.

2008 MacArthur Fellowship

Regina Benjamin, the AMA’s Chairman of Council on Ethical and Judicial Affairs, has been named as a 2008 recipient of a prestigious MacArthur Fellowhip. The fellowships are given to individuals who show exceptional creativity in their work and the prospect for still more in the future, and comprise an award of $500,000, paid in quarterly installments over five years.

Benjamin is a rural family physician working in one of the most underserved regions of the United States. In 1990, she founded the Bayou La Batre Rural Health Clinic to serve the Gulf Coast fishing community of Bayou La Batre, Alabama. She has established a family practice that allows her to treat all incoming patients, many of whom are uninsured, and frequently travels by pickup truck to care for the most isolated and immobile in her region.