- The Washington Times - Monday, June 15, 2009

President Obama told the country’s largest physician organization Monday that a government-owned “public” insurance plan would not reimburse them at the traditionally low rates Medicare has used, addressing one of their chief concerns in an attempt to get them on board with his reform plans.

“With reform, we will ensure that you are being reimbursed in a thoughtful way tied to patient outcomes instead of relying on yearly negotiations [over reimbursement rates],” he said. “The alternative is a world where health care costs grow at an unsustainable rate, threatening your reimbursements and the stability of our health care system.”

Mr. Obama traveled to his hometown of Chicago to address the American Medical Association, which opposes his plans to implement a public insurance program, as the health care reform debate enters a critical “make-or- break” period on Capitol Hill.

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Many of Mr. Obama’s liberal supporters see the taxpayer-financed public option as critical to reform, in part to put pressure on private insurers to expand coverage and restrain costs.

“Now, I know there’s some concern about the public option,” he said to the gathered physicians. “In particular, I understand that you are concerned that today’s Medicare rates will be applied broadly in a way that means our cost savings are coming off your backs. These are legitimate concerns, but ones, I believe, that can be overcome.”

Mr. Obama said public plan reimbursements would be based on patient care instead of individual tests or medical procedures. For instance, a doctor would be reimbursed a set rate for treating an individual with diabetes instead of being paid for the individual procedures required. Incentives would be included for healthy outcomes.

Mr. Obama addressed the sharpest criticism to his health care proposals: that the public plan would lead to socialized medicine.

“No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period,” he said.

Rep. Tom Price, Georgia Republican and AMA member, said association members are concerned that the public plan will eliminate their control over patient care.

“The No. 1 concern is where these medical decisions are going to be made,” said Mr. Price, a nonpracticing orthopedic surgeon, on a conference call with reporters from Chicago.

His concern, widely held by Republicans, is that a public plan would reimburse at such low rates that it would tilt the market, driving private insurers out of business, and leaving the government plan as the only option.

“When the government is running something, it subsidizes it to the point private industry can’t compete,” he said, pointing to Fannie Mae and Freddie Mac as examples of government-run programs.

Mr. Obama also told the group that he supports physician-friendly proposals such as computerized medical records and preventive care. But said he opposes putting a cap on malpractice awards, a move physicians strongly favor.

In addition to the public plan, Mr. Obama said he supports insurance mandates on employers and individuals, as long as there are exceptions for small business owners and the poor. He also wants to establish health insurance exchanges, in which consumers can choose between various private health insurance options as well as the public plan.

Mr. Obama stressed that reform must come now. He has said that if a bill doesn’t pass Congress by the August recess, it isn’t going to happen at all. But the group of nearly 250,000 physicians has a history of opposing change in its industry.

During the 1993 work to reform health care, the AMA teamed with insurers to help quash the effort. The group also opposed the created of Medicare in 1965.

“There is a fear of change — a worry that we may lose what works about our health care system while trying to fix what doesn’t,” Mr. Obama said, adding that today is different.

“Part of the reason is because the different groups involved — physicians, insurance companies, businesses, workers and other — simply couldn’t agree on the need for reform or what shape it would take,” he said.

The speech to the AMA is Mr. Obama’s second health care-related public event. He attended a question-and-answer session in Green Bay, Wis., last week.

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