In Pitch to AMA, Obama Paints Mixed Picture

By Ceci Connolly
Washington Post Staff Writer
Tuesday, June 16, 2009

CHICAGO, June 15 -- President Obama wooed the American Medical Association on Monday with talk of curbing malpractice lawsuits and canceling a proposed 21 percent cut in Medicare payments as he ramped up a newly aggressive effort to line up industry support for an overhaul of the nation's health system.

But he pointedly refused to endorse the group's top goal -- caps on damage awards -- and steadfastly defended creation of a government-sponsored health insurance program, which many physicians oppose. "The public option is not your enemy; it is your friend," Obama told the doctors.

The president's good-news, bad-news message to the physicians marked what White House senior adviser David Axelrod described as a higher level of engagement by the president on his top domestic priority.

For months, Obama remained on the sidelines of the health-care debate because "he felt it was important to not be too proscriptive," Axelrod said in an interview. "Now we're into a different phase, where decisions are being made very quickly, so it's time to weigh in to a greater degree."

The Obama strategy, articulated in the speech here and in a series of private meetings, is to present each major stakeholder with an enticement in return for a bit of sacrifice.

To insurers, Obama offered a concession and a warning. In a shift from his position during the presidential campaign, he is willing to support a requirement that every American have health insurance, which could translate into more than 40 million new customers for the industry.

"Insurance companies have expressed support for the idea of covering the uninsured -- and I welcome their willingness to engage constructively in the reform debate. I'm glad they're at the table," Obama said. "But what I refuse to do is simply create a system where insurance companies suddenly have a whole bunch more customers on Uncle Sam's dime but still fail to meet their responsibilities."

Some interest groups have begun to balk as the president has staked out his position in greater detail.

Over the weekend, Obama outlined $313 billion in cuts to Medicare and Medicaid aimed primarily at the revenue of hospitals and drugmakers.

The American Hospital Association said in a statement that it was "deeply disappointed and concerned" by the announcement.

"Hospitals have long supported expanding health care coverage to all Americans but feel this must happen while maintaining adequate financing for hospitals that serve large numbers of poor and uninsured patients," the group said.

Lobbyists for leading drug companies also were unenthusiastic, saying privately that Obama cannot expect to pay for his ambitious expansion of health coverage by squeezing the private sector.

"The message is: Everybody has got to put something on the table," said Sen. Ron Wyden (D-Ore.), who has participated in several White House meetings on health care.

But immediate reaction to Obama's speech Monday illustrated that it will not be easy to neutralize some of the powerful forces that helped defeat previous attempts at health-care reform.

"He's a wonderful speaker, and he told us what we want to hear," said Norman Dunitz, a Tulsa hip and knee surgeon. "The question isn't what he said but what he's going to do. He has a reputation of shifting sides."

Obama brought the doctors to their feet with a hint that he is willing to provide some level of malpractice relief, perhaps the top legislative priority of the physicians lobby.

"Now, I recognize that it will be hard to make some of these changes if doctors feel like they're constantly looking over their shoulders for fear of lawsuits," he said. "I understand some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That's a real issue."

But he drew some boos when he warned that he would not give doctors what they most desire.

"I want to be honest with you," he said. "I'm not advocating caps on malpractice awards, which I personally believe can be unfair to people who've been wrongfully harmed."

James Rohack, the incoming AMA president, said physicians must receive some type of legal protection if they are going to be expected to reduce extraneous tests and treatments, as Obama urged.

"Unless we have protection in the courtroom for not ordering a test, we're going to order those additional tests," Rohack told reporters after the speech.

Like malpractice reform, the notion of setting up a new, government-run insurance plan has become a flash point for many AMA members. The group's leaders have said the AMA would oppose mandatory participation in such a program or one that sets payment rates in the same fashion as Medicare.

In his speech, Obama said, "Let me also address an illegitimate concern that's being put forward by those who are claiming that a public option is somehow a Trojan horse for a single-payer system. . . . When you hear the naysayers claim that I'm trying to bring about government-run health care, know this: They're not telling the truth."

Peter Schwartz, a Pennsylvania gynecologist, appeared reassured.

"He reaffirmed that he's not moving us toward a single-payer system, which many of us were concerned about," he said afterward.

But many were alarmed by Obama's talk of squeezing what he described as waste out of the system by curtailing needless procedures.

Ohio physician Colette R. Willins said that even when sound guidelines suggest a particular test is not needed, "an attorney will find that situation where you didn't do the test for that one person in 100,000 who needed it."

The AMA, with about 250,000 members, is the nation's largest physician group. It gave more than $1.8 million to federal candidates in the last election cycle, according to data analyzed by the Center for Responsive Politics.

Staff writer Kari Lydersen contributed to this report.

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