CHICAGO – It may have been this year’s tempest in a teapot: After some premeeting scuffles and a marginally exercised debate in committee, the American Medical Association’s House of Delegates calmly voted to direct the organization to explore Medicare financing options, including a defined-contribution program.
The vote was a step back from the wholehearted endorsement of a so-called premium support plan that had circulated before the meeting.
Dr. William E. Golden
The AMA’s Council on Medical Service had prepared a report for delegates to debate, on options for propping up Medicare over the long term. The report came out in favor of building "on existing policies to support making Medicare a defined contribution program," and crafted a resolution urging the AMA to support "transitioning Medicare to a premium support program."
But a few days before the House got underway, the council withdrew its report and recommendation. Dr. Tom Sullivan, the council chairman, said in a statement that it was withdrawn because the council "believes there is a need to put in additional work on a revised report that addresses a number of complicated policy issues."
The Louisiana delegation was not pleased. It sought – and eventually won – the ability to put the council’s resolution back on the table. That resolution was hotly debated during a committee hearing on the second day of the House of Delegates meeting.
Many delegates argued in favor of supporting a defined-contribution plan for Medicare, saying that the idea already was incorporated into existing AMA policy.
But others worried about what taking a stand on Medicare financing could do to the AMA’s credibility and standing in an election year.
"It’s a potentially politically polarizing stance we’re asking the AMA to take," said Dr. Charles Rothberg, an ophthalmologist with the New York delegation. He also asked why the House was being asked to take such urgent action.
Dr. Nancy Nielsen, the immediate past-president of the AMA, also cautioned against moving too quickly. She urged delegates to take more time to think about Medicare financing options, noting that a wrong move could raise the ire of senior citizens.
When the issue came to the floor for a vote, delegates voted to approve a weakened substitute resolution that directed the AMA to explore all options, including premium support, and "to consider mechanisms to adjust contributions in order to ensure that health insurance coverage remains affordable for all beneficiaries."
The council was directed to report back to the AMA at its interim meeting, which will be held after the November election.
After the vote, Dr. Donald Palmisano, a former AMA president and member of the Louisiana delegation, said in an interview that "it confirms long-standing policy use of a defined-contribution model for the purchase of insurance." Dr. Palmisano added, "We need a system that protects seniors and the disabled and also keeps doctors in the practice of medicine."
Dr. William E. Golden, head of the American College of Physicians’ delegation, said in an interview that the ACP was pleased with the notion that the AMA would further study premium support. The ACP has urged against a quick transformation of Medicare from a defined benefit to a defined contribution.
But in a white paper on Medicare reform released in April the ACP backed a deeper investigation of premium support.