How Can the AMA Wield Such Power in Health Reform? The DMCB Explains

There they go again. Tossing a monkey into the wrench of Senator Reid's fragile health reform compromise, the American Medical Association has come out against the Medicare buy-in plan for persons age 55 to 64 years. While physicians, hospitals and insurers dislike the economics, the AMA has stressed that it's Medicare budgetary woes that are the real problem. Things are on hold until the Congressional Budget Office 'scores' this latest scheme.

Let the games continue.

But who IS this AMA and how can an organization with a membership that is only a fraction of all U.S physicians wield such clout? There are other physician groups out there, there is no shortage of docs that vociferously oppose the AMA's positions and some of them have the President's ear. Yet, when the AMA rises in oppotion to the motion, Presidents, Legislators and the media still pause and listen.

The Disease Management Care Blog explains.

1) Despite having a membership that comprises only minority of physicians, it is still the nation's largest physician organization.

2) While there are sufficient numbers of docs to fill a Rose Garden for the cameras or create impressive web sites, the AMA argues that it also represents the silent majority of politically inactive and non-dues paying physicians who don't belong to any advocacy group. They may have a point.

3) While many physicians are members of 'other' professional specialty-based organizations, a huge number of those organizations participate in the AMA. The AMA has been referred to as the House of Medicine for a good reason.

4) Despite attempts of some hostile media to convince folks otherwise, the 'AMA' has a recognizable advocacy 'brand.' It makes no difference if, as many allege, that the association is slowly losing it's grip on the physicians' conscience, the public believes it still has it. The President's political calculus recognizes that. By the way, so does the AMA - and they just might.

5) You may call it lobbying, but the AMA has an impressive policy infrastructure that has been long relied on Inside The Beltway for its expertise. Their insider access is not a function of money or lobbyists but history, relationships and insights.

6) JAMA, a premier peer review journal that is must reading for any physician. 'Nuff said.

The DMCB is a proud member of the AMA. While it may not agree with all of the House of Medicine's positions, it thinks it has a greater voice by being a dues paying participant. It immodestly believes the AMA is better off for it.

Medicare Fee Schedule Cuts, Private Fee For Service, the AMA and Hand Gestures

The Disease Management Care Blog thought Karen Ignagni had cornered the hand gesture market. Ms. Ignagni’s classic two-handed chops, sweeps and grabs in her speeches not only help emphasize her points, but remind the DMCB of a martial artist's kata. Observe Ms. Ignagni’s interview here (once the initial question is over) and this classic kung-fu exercise and see if you can tell the difference.

Well stand back, because Nancy Nielsen, MD, President of the AMA has her own repertoire of jabs, pokes and pushes that accentuate her organization's considerable annoyance at the U.S. Senate’s recent failure to cancel a scheduled 10.6% fee schedule cut by transferring the necessary funding from the private fee for service (PFFS) Medicare plans. Dr. Nielsen and Ms. Ignagni obviously stand on opposite sides on this issue, and the DMCB recommends someone get these two experts together not only for what would be a hugely educational discussion but for an equally entertaining hand gesture smack-down.

Want to learn more about this Republican-Democrat health care kerfuffle? In the opinion of the DMCB, the best summary can be found here at the Health Affairs blog site.

But the DMCB wanted to learn more about hand gestures. This is an excellent article from Scientific American that explains speech and hand gestures are hard wired together in humans. For example, babies who have not yet learned to speak use gestures, while persons with damage to the brain’s ‘speech centers’ lose their ability to interpret gestures. In addition, humans (and primates) are vicariously endowed with ‘mirror neurons’ that are not only activated when we perform a movement but when we observe another person performing the same movement. Numerous studies that have shown speech plus gestures results in far better communication than speech alone.

In fact, this hand-speech connection may be so hardwired, that having your mouth say one thing and your hands do another can be a telling clue to an audience that something is amiss. Unsurprisingly, the best medium for observing this mismatch can be found in politics. Not getting this right can make all the difference in a contender’s career, which is why considerable time and effort may be needed to tie a speech and the movements ‘naturally’ together.

In the meantime, the DMCB has trouble understanding what the Medicare physician fee schedule has to with Medicare PFFS. It has to admit, however, that tying them together and forcing the PFFS supporters to vote ‘against physicians’ was a stroke of partisan genius. Too bad it’s also another example of the manipulative gamesmanship that can get in the way of real health care reform. To the folks in Congress, here’s a gesture from the DMCB to all of you.