Obama at AMA: Flattery Plus Hardball Might Get Him Somewhere

Measured by audience reaction, the American Medical Association likes President Obama better than it likes insurance companies, and it seems more concerned about malpractice lawsuits than the prospect of a new government health plan to compete with private insurers. That doesn't put the AMA in Obama's corner on health reform, but he may have some room to maneuver.Obama is the first president since Ronald Reagan to talk to the influential doctors group, which has more than 230,000 members. His speech to AMA delegates in Chicago lasted nearly an hour and earned him about 50 bursts of applause.

The president anticipated the boos he'd get for saying he opposes liability caps in malpractice suits ("I want to be honest with you," he said, they can be "unfair to people who've been wrongfully harmed"). He was met with silence when he said that "vast amounts of money" are spent on procedures patients don't need, and that doctors should be paid based on quality of care rather than quantity.

But more surprising than the boos or silence was the smattering of applause for a central point of contention in the larger health-care debate: Obama's call to add a government-run insurance plan to the private options people already have. Doctors disagree on whether there should be a public option, and the AMA recently has been sending mixed signals about what type of public plan it would find acceptable, if any.

The massive task facing Obama and Congress was underscored by the fact that malpractice and the public option, both huge issues in themselves, consumed just a few minutes of his lengthy speech. In fact, both sides in the public option debate held conference calls with reporters before he spoke.

From the left, Richard Kirsch, national campaign manager for the 1,000-group coalition Health Care for America Now, highlighted the organization's five-figure buy for a cable ad in the Washington, DC area stressing broad public support for a public option. The AMA, he said, represents only a quarter of all physicians and is out of step. "The AMA has a history of opposing reform," he said. "They opposed Medicare."

From the right, Rep. Tom Price, R-Ga., a former orthopedic surgeon, said he was at the AMA meeting in Chicago. He said the Obama plan would force people into a government-run plan and transfer treatment decisions from doctors and patients to a government research board with no doctors on it. "There's no doubt that care would be denied" people who are old or terminally ill, he said. (Update: The research board website shows more than half the members are doctors).

Obama spent considerable time at the AMA anticipating and countering lines of attack like that. "If you like your doctor, you will be able to keep your doctor. Period," he said. "If you like your health care plan, you will be able to keep your health care plan. Period."

As for that research board, Obama said it's meant to identify effective treatments and spread the findings quickly to doctors. "Let me be clear: Identifying what works is not about dictating what kind of care should be provided," he said to applause. "It's about providing patients and doctors with the information they need to make the best medical decisions."

Obama also knocked down the idea that people would be forced into a public plan. People who don't like their coverage or don't have any, he said, would comparison shop among private plans and a public option at a Health Insurance Exchange. Anyone who claims Obama wants a single-payer, government-run system, is "not telling the truth," he said.

Oh, and about the exploding federal budget deficit? Obama went into great detail about how he would like to offset the $1 trillion-plus cost of doing what he wants to do. Opponents already are mobilizing against some of his proposals, which include restructured Medicare reimbursements and "modest" limits on tax deductions for charitable giving.

In addition to waging pre-emptive rhetorical warfare, Obama took pains to court his opponents. He praised AMA members for the nobility of their calling, their commitment to reduce health costs and their work for a tobacco regulation bill that just passed Congress. He said he wanted to strengthen a Medicare savings panel created by a Republican Congress and, in a moment he acknowledged was rare, quoted former House Speaker Newt Gingrich as having "rightly pointed out, we do a better job tracking a FedEx package in this country than we do tracking a patients' health records."

The doctors reacted enthusiastically when Obama talked about the nation's obligation to cover the uninsured and the need to promote healthy living habits to prevent disease. But they seemed especially enthused whenever Obama criticized insurers, which was frequently.

They applauded loudly, for instance, when he mentioned a doctor who spent 20 percent of his time dealing with insurance; said doctors should be healers, not "bean-counters and paper-pushers;" asserted that a public plan would "keep the insurance companies honest;" and pledged to end overpayments to private companies that provide Medicare benefits. They erupted in cheers when he said insurers will have to meet their responsibilities – "the days of cherry-picking who to cover and who to deny, those days are over.''

Beyond flattering doctors, criticizing insurers and defending himself, Obama worked mightily to create a sense of urgency. He said the fate of the U.S. economy depends on taking action right now. "If we do not fix our health care system, America may go the way of GM: paying more, getting less, and going broke."

Talk about the ultimate scare tactic. Maybe it'll work.